JERREYLL T JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

JERREYLL

Middle

Last Name

JACKSON

Suffix

Business Name

JERREYLL T JACKSON MD

Original Issue Date

10/25/2002

Effective Date

10/25/2002

Expiration Date

07/31/2005

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006