POTHEN JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

POTHEN

Last Name

JACOB

Suffix

Business Name

POTHEN JACOB MD

Original Issue Date

01/01/1997

Effective Date

05/22/2014

Expiration Date

07/31/2017

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017