JACK J MASTER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000625

License Status

NOT RENEWED

Business

First Name

JACK J

Last Name

MASTER

Business Name

JACK J MASTER

Original Issue Date

09/15/1994

Effective Date

09/15/1994

Expiration Date

03/01/2004

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006