JARED BUFORD CORNELISON - Physician Assistant License in Idaho | # 38*****48

JARED BUFORD CORNELISON

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****48

License Status

INOPERATIVE

Business

N

First Name

JARED

Middle

BUFORD

Last Name

CORNELISON

Business Name

JARED BUFORD CORNELISON

Original Issue Date

11/01/2012

Effective Date

11/01/2012

Expiration Date

03/01/2014

State

ID

Ever Disciplined

N

LastModifiedDate

11/01/2012