SODARAN P JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

NOT RENEWED

Business

First Name

SODARAN P

Last Name

JACOB

Suffix

Business Name

SODARAN P JACOB MD

Original Issue Date

08/01/1991

Effective Date

08/01/1991

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008