JACOB CHACKO TONY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046927

License Status

CANCELLED

Business

First Name

JACOB

Middle

CHACKO

Last Name

TONY

Suffix

Business Name

JACOB CHACKO TONY MD

Original Issue Date

07/21/2003

Effective Date

07/21/2003

Expiration Date

07/20/2007

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

09/22/2006