JACOB CHACKO TONY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

ACTIVE

Business

First Name

JACOB

Middle

CHACKO

Last Name

TONY

Suffix

Business Name

JACOB CHACKO TONY MD

Original Issue Date

04/01/2008

Effective Date

07/16/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/16/2023