LISA CHANEL JACKSON MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041588

License Status

EXPIRED

Business

First Name

LISA

Middle

CHANEL

Last Name

JACKSON

Suffix

Business Name

LISA CHANEL JACKSON MD

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

07/17/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006