MARK L LEAFGREEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000049

License Status

NOT RENEWED

Business

First Name

MARK

Middle

Last Name

LEAFGREEN

Business Name

MARK L LEAFGREEN

Original Issue Date

11/05/1978

Effective Date

11/05/1978

Expiration Date

11/05/1980

City

WASHINGTON

State

Zip

61571

County

TAZEWELL

Ever Disciplined

LastModifiedDate

09/11/2008