ALI BEN-JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

First Name

ALI

Last Name

BEN-JACOB

Suffix

Business Name

ALI BEN-JACOB MD

Original Issue Date

08/23/2000

Effective Date

08/23/2000

Expiration Date

07/31/2002

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006