SCOTT RICHARD JACOB MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****77

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

RICHARD

Last Name

JACOB

Suffix

Business Name

SCOTT RICHARD JACOB MD

Original Issue Date

07/10/2000

Effective Date

07/10/2000

Expiration Date

07/31/2005

City

SCOTT AFB

State

Zip

62225

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006