TIPHANY DEE JACKSON JOHNSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

Title

First Name

TIPHANY

Middle

DEE

Last Name

JACKSON JOHNSON

Business Name

TIPHANY DEE JACKSON JOHNSON MD

Original Issue Date

04/29/2020

Effective Date

07/21/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60653

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/21/2023