TERRENCE R JACKSON WISE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045222

License Status

EXPIRED

Business

First Name

TERRENCE

Middle

R JACKSON

Last Name

WISE

Suffix

Business Name

TERRENCE R JACKSON WISE MD

Original Issue Date

06/25/2002

Effective Date

06/25/2002

Expiration Date

06/24/2005

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006