MARK D JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036082717

License Status

NOT RENEWED

Business

First Name

MARK D

Last Name

JACKSON

Suffix

Business Name

MARK D JACKSON MD

Original Issue Date

06/26/1991

Effective Date

09/01/2020

Expiration Date

07/31/2023

City

MAPLETON

State

Zip

61547

County

TAZEWELL

Ever Disciplined

LastModifiedDate

11/30/2023