SCOTT RICHARD JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036102570

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

RICHARD

Last Name

JACOB

Suffix

Business Name

SCOTT RICHARD JACOB MD

Original Issue Date

05/30/2000

Effective Date

05/30/2000

Expiration Date

07/31/2005

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

10/09/2006