LISSIAMMA JACOB MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036054052

License Status

INACTIVE

Business

First Name

LISSIAMMA

Last Name

JACOB

Suffix

Business Name

LISSIAMMA JACOB MD

Original Issue Date

01/13/1977

Effective Date

07/15/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

04/08/2014