JACKSON CUNNINGHAM GRAVES MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

ACTIVE

Business

Title

First Name

JACKSON

Middle

CUNNINGHAM

Last Name

GRAVES

Business Name

JACKSON CUNNINGHAM GRAVES MD

Original Issue Date

11/01/2022

Effective Date

08/01/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/01/2023