HOLLACE D JACKSON Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105573

License Status

NOT RENEWED

Business

First Name

HOLLACE

Middle

Last Name

JACKSON

Business Name

HOLLACE D JACKSON

Original Issue Date

09/12/2001

Effective Date

09/12/2001

Expiration Date

07/31/2005

City

GREENLAWN

State

Zip

11740

County

NEW YORK

Ever Disciplined

LastModifiedDate

10/09/2006