POTHEN JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

POTHEN

Last Name

JACOB

Suffix

Business Name

POTHEN JACOB MD

Original Issue Date

05/13/1986

Effective Date

05/13/1986

Expiration Date

07/31/1987

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017