JASON R DAVENPORT Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036121358

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

DAVENPORT

Business Name

JASON R DAVENPORT

Original Issue Date

07/01/2008

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

11/01/2017