GARTH R JACOBSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

First Name

GARTH

Middle

Last Name

JACOBSEN

Suffix

Business Name

GARTH R JACOBSEN MD

Original Issue Date

03/23/2007

Effective Date

03/23/2007

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011