PHILIP LARKIN JACKSON III MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068736

License Status

CANCELLED

Business

Title

First Name

PHILIP

Middle

LARKIN

Last Name

JACKSON

Suffix

III

Business Name

PHILIP LARKIN JACKSON III MD

Original Issue Date

06/23/2016

Effective Date

06/23/2016

Expiration Date

06/22/2019

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

04/19/2016