MATTHEW N JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

Title

First Name

MATTHEW

Middle

Last Name

JACKSON

Business Name

MATTHEW N JACKSON MD

Original Issue Date

11/04/2015

Effective Date

11/04/2015

Expiration Date

07/31/2017

City

CHILLICOTHE

State

Zip

61523

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020