DALE GARY JACOBSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

DALE GARY

Last Name

JACOBSON

Suffix

Business Name

DALE GARY JACOBSON MD

Original Issue Date

06/29/1981

Effective Date

06/29/1981

Expiration Date

09/01/1982

City

WALWORTH

State

Zip

53184

County

WISCONSIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006