JACKSON E FOWLER JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

First Name

JACKSON E

Last Name

FOWLER JR

Suffix

Business Name

JACKSON E FOWLER JR MD

Original Issue Date

07/09/1987

Effective Date

07/09/1987

Expiration Date

07/31/1993

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006