BENJAMIN JOHN JACOBS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

JOHN

Last Name

JACOBS

Suffix

Business Name

BENJAMIN JOHN JACOBS MD

Original Issue Date

04/03/2007

Effective Date

04/03/2007

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

I II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011