SAMUEL JACOB MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056612

License Status

EXPIRED

Business

Title

First Name

SAMUEL

Last Name

JACOB

Business Name

SAMUEL JACOB MD

Original Issue Date

06/29/2009

Effective Date

06/29/2009

Expiration Date

06/28/2011

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

07/19/2011