JACOB RUSSELL PORTER DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070228

License Status

EXPIRED

Business

Title

First Name

JACOB

Middle

RUSSELL

Last Name

PORTER

Business Name

JACOB RUSSELL PORTER DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medical Services

Ever Disciplined

LastModifiedDate

11/19/2020