JASON M COLLINS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110471

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

COLLINS

Business Name

JASON M COLLINS

Original Issue Date

11/19/2003

Effective Date

11/19/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60643

County

COOK

Ever Disciplined

LastModifiedDate

01/24/2007