DALLAS WYOTT LIPSCOMB - Physician Assistant License in Illinois | # 085001343

DALLAS WYOTT LIPSCOMB

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001343

License Status

NOT RENEWED

Business

N

First Name

DALLAS

Middle

WYOTT

Last Name

LIPSCOMB

Business Name

DALLAS WYOTT LIPSCOMB

Original Issue Date

01/18/2000

Effective Date

02/27/2012

Expiration Date

03/01/2014

State

IL

Ever Disciplined

N

LastModifiedDate

03/16/2015