GERALD A JACOBY MD Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED PHYSICIAN

License Number

002020154-0002

License Status

NOT RENEWED

Business

First Name

GERALD A

Last Name

JACOBY

Suffix

Business Name

GERALD A JACOBY MD

Original Issue Date

06/04/1975

Effective Date

06/04/1975

Expiration Date

06/04/1976

City

CAROL STREAM

State

Zip

60187

County

DUPAGE

Ever Disciplined

LastModifiedDate

09/18/2006