JARED BUFORD CORNELISON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004475

License Status

NOT RENEWED

Business

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

City

POCATELLO

State

Zip

83201

County

IDAHO

Ever Disciplined

LastModifiedDate

04/08/2014