BENNETT G MILLER III Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000577

License Status

INACTIVE

Business

First Name

BENNETT G

Last Name

MILLER III

Business Name

BENNETT G MILLER III

Original Issue Date

01/10/1994

Effective Date

01/10/1994

Expiration Date

03/01/1996

City

PEORIA

State

Zip

61603

County

PEORIA

Ever Disciplined

LastModifiedDate

09/26/2006