JACOB RUSSELL POWELL DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060219

License Status

EXPIRED

Business

Title

First Name

JACOB

Middle

RUSSELL

Last Name

POWELL

Business Name

JACOB RUSSELL POWELL DO

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2012

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Rotating Internship

Ever Disciplined

LastModifiedDate

08/29/2012