JASON MICHAEL LONG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047689

License Status

CANCELLED

Business

First Name

JASON

Middle

MICHAEL

Last Name

LONG

Suffix

Business Name

JASON MICHAEL LONG MD

Original Issue Date

06/24/2004

Effective Date

06/24/2004

Expiration Date

06/23/2007

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006