JOHN HUMPHREY JACOBSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

JOHN HUMPHREY

Last Name

JACOBSEN

Suffix

Business Name

JOHN HUMPHREY JACOBSEN MD

Original Issue Date

10/23/1981

Effective Date

06/21/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021