JARED BUFORD CORNELISON - Physician Assistant License in Idaho | # 085004475

JARED BUFORD CORNELISON

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004475

License Status

NOT RENEWED

Business

N

First Name

JARED

Middle

BUFORD

Last Name

CORNELISON

Business Name

JARED BUFORD CORNELISON

Original Issue Date

09/27/2012

Effective Date

09/27/2012

Expiration Date

03/01/2014

State

ID

Ever Disciplined

N

LastModifiedDate

04/08/2014