JACOB NATHANIEL MATTOX MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

Title

First Name

JACOB

Middle

NATHANIEL

Last Name

MATTOX

Business Name

JACOB NATHANIEL MATTOX MD

Original Issue Date

11/07/2022

Effective Date

11/07/2022

Expiration Date

07/31/2023

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023