BRANT MICHAEL BALTHAZOR - Physician Assistant License in Wisconsin | # 085005469

BRANT MICHAEL BALTHAZOR

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005469

License Status

INACTIVE

Business

N

First Name

BRANT

Middle

MICHAEL

Last Name

BALTHAZOR

Business Name

BRANT MICHAEL BALTHAZOR

Original Issue Date

05/27/2015

Effective Date

01/15/2020

Expiration Date

03/01/2022

State

WI

Ever Disciplined

N

LastModifiedDate

01/06/2022