BRENT ROBERT JACOBSON DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

Title

First Name

BRENT

Middle

ROBERT

Last Name

JACOBSON

Business Name

BRENT ROBERT JACOBSON DO

Original Issue Date

04/22/2009

Effective Date

04/22/2009

Expiration Date

07/31/2011

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020