LORI R JACKSON MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049752

License Status

EXPIRED

Business

First Name

LORI

Middle

Last Name

JACKSON

Suffix

Business Name

LORI R JACKSON MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

CHAMPAIGN

State

Zip

61822

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/31/2008