JACOB DARRELL JENSEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

Title

First Name

JACOB

Middle

DARRELL

Last Name

JENSEN

Business Name

JACOB DARRELL JENSEN DO

Original Issue Date

08/26/2016

Effective Date

08/26/2016

Expiration Date

07/31/2017

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017