JARED BUFORD CORNELISON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****48

License Status

INOPERATIVE

Business

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

City

POCATELLO

State

Zip

83201

County

IDAHO

Ever Disciplined

LastModifiedDate

11/01/2012