ROOSEVELT T JACKSON JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

ROOSEVELT T

Last Name

JACKSON JR

Suffix

Business Name

ROOSEVELT T JACKSON JR MD

Original Issue Date

11/12/1981

Effective Date

11/12/1981

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006