MATTHEW N JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

NOT RENEWED

Business

Title

First Name

MATTHEW

Middle

Last Name

JACKSON

Business Name

MATTHEW N JACKSON MD

Original Issue Date

03/20/2014

Effective Date

04/16/2014

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020