LISSIAMMA JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

LISSIAMMA

Last Name

JACOB

Suffix

Business Name

LISSIAMMA JACOB MD

Original Issue Date

01/01/1997

Effective Date

07/21/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014