JEFFREY R BERGQUIST - Physician Assistant License in Illinois | # 085000969

JEFFREY R BERGQUIST

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000969

License Status

INACTIVE

Business

N

First Name

JEFFREY

Middle

R

Last Name

BERGQUIST

Business Name

JEFFREY R BERGQUIST

Original Issue Date

01/20/1998

Effective Date

01/20/1998

Expiration Date

03/01/2006

State

IL

Ever Disciplined

N

LastModifiedDate

10/09/2006