MARK D JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

MARK D

Last Name

JACKSON

Suffix

Business Name

MARK D JACKSON MD

Original Issue Date

07/02/1991

Effective Date

09/01/2020

Expiration Date

07/31/2023

City

PEKIN

State

Zip

61554

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023