JACOB DARRELL JENSEN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065738

License Status

CANCELLED

Business

Title

First Name

JACOB

Middle

DARRELL

Last Name

JENSEN

Business Name

JACOB DARRELL JENSEN DO

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/29/2014