RANDALL LANE WILCOXEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000632

License Status

NOT RENEWED

Business

First Name

RANDALL

Middle

LANE

Last Name

WILCOXEN

Business Name

RANDALL LANE WILCOXEN

Original Issue Date

11/28/1994

Effective Date

02/05/2016

Expiration Date

03/01/2018

City

CHILLICOTHE

State

Zip

61523

County

PEORIA

Ever Disciplined

LastModifiedDate

05/10/2018