GRACE JACKSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

ACTIVE

Business

Title

First Name

GRACE

Last Name

JACKSON

Business Name

GRACE JACKSON MD

Original Issue Date

09/22/2020

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/22/2023