KEITH J CARLSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000097

License Status

NOT RENEWED

Business

First Name

KEITH J

Last Name

CARLSON

Business Name

KEITH J CARLSON

Original Issue Date

01/25/1981

Effective Date

01/25/1981

Expiration Date

01/25/1983

City

NASHVILLE

State

Zip

62263

County

WASHINGTON

Ever Disciplined

LastModifiedDate

09/26/2006