LENLEY B JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****67

License Status

NOT RENEWED

Business

Title

First Name

LENLEY

Middle

Last Name

JACKSON

Business Name

LENLEY B JACKSON MD

Original Issue Date

10/16/2007

Effective Date

06/11/2008

Expiration Date

07/31/2011

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011