STEPHEN DOUGLAS BAST Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000207

License Status

NOT RENEWED

Business

First Name

STEPHEN DOUGLAS

Last Name

BAST

Business Name

STEPHEN DOUGLAS BAST

Original Issue Date

08/20/1980

Effective Date

08/20/1980

Expiration Date

08/20/1984

City

CARMI

State

Zip

62821

County

WHITE

Ever Disciplined

LastModifiedDate

03/06/2015