EDGAR BASIL JACKSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036053100

License Status

NOT RENEWED

Business

First Name

EDGAR BASIL

Last Name

JACKSON

Suffix

Business Name

EDGAR BASIL JACKSON MD

Original Issue Date

07/15/1976

Effective Date

04/29/2014

Expiration Date

07/31/2017

City

MENOMONEE FALLS

State

Zip

53051

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/01/2017