LENLEY B JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036119364

License Status

NOT RENEWED

Business

Title

First Name

LENLEY

Middle

Last Name

JACKSON

Business Name

LENLEY B JACKSON MD

Original Issue Date

09/07/2007

Effective Date

06/11/2008

Expiration Date

07/31/2011

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

11/14/2011