JACOB TRAVIS PARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005291

License Status

ACTIVE

Business

First Name

JACOB

Middle

TRAVIS

Last Name

PARK

Business Name

JACOB TRAVIS PARK

Original Issue Date

10/06/2014

Effective Date

12/10/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

12/10/2025