JACK MICHAEL GIBSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

First Name

JACK MICHAEL

Last Name

GIBSON

Suffix

Business Name

JACK MICHAEL GIBSON MD

Original Issue Date

07/12/1982

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023