RANDY ELLIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000027

License Status

NOT RENEWED

Business

First Name

RANDY

Last Name

ELLIS

Business Name

RANDY ELLIS

Original Issue Date

11/05/1980

Effective Date

11/05/1980

Expiration Date

11/05/1984

City

GODFREY

State

Zip

62035

County

MADISON

Ever Disciplined

LastModifiedDate

09/26/2006