ROBERT DOUGLAS BENJAMIN JAQUISS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

ROBERT DOUGLAS

Middle

BENJAMIN

Last Name

JAQUISS

Suffix

Business Name

ROBERT DOUGLAS BENJAMIN JAQUISS MD

Original Issue Date

09/27/2002

Effective Date

09/27/2002

Expiration Date

07/31/2008

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008