JACOB TRAVIS PARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****95

License Status

ACTIVE

Business

First Name

JACOB

Middle

TRAVIS

Last Name

PARK

Business Name

JACOB TRAVIS PARK

Original Issue Date

10/29/2014

Effective Date

12/10/2025

Expiration Date

03/01/2028

City

CHICAGO

State

Zip

60657

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/10/2025