ALLEN T JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036102116

License Status

NOT RENEWED

Business

First Name

ALLEN

Middle

Last Name

JACKSON

Suffix

Business Name

ALLEN T JACKSON MD

Original Issue Date

03/13/2000

Effective Date

03/13/2000

Expiration Date

07/31/2005

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

04/24/2007