JACOB MARK BURDETT DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

ACTIVE

Business

Title

First Name

JACOB

Middle

MARK

Last Name

BURDETT

Business Name

JACOB MARK BURDETT DO

Original Issue Date

06/10/2022

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2023