EDGAR BASIL JACKSON MD - Medical Doctor License in Wisconsin | # 036053100

EDGAR BASIL JACKSON MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036053100

License Status

NOT RENEWED

Business

N

First Name

EDGAR BASIL

Last Name

JACKSON

Suffix

MD

Business Name

EDGAR BASIL JACKSON MD

Original Issue Date

07/15/1976

Effective Date

04/29/2014

Expiration Date

07/31/2017

State

WI

Ever Disciplined

N

LastModifiedDate

11/01/2017