JEFFREY R BERGQUIST Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000969

License Status

INACTIVE

Business

First Name

JEFFREY

Middle

Last Name

BERGQUIST

Business Name

JEFFREY R BERGQUIST

Original Issue Date

01/20/1998

Effective Date

01/20/1998

Expiration Date

03/01/2006

City

WAUKEGAN

State

Zip

60085

County

LAKE

Ever Disciplined

LastModifiedDate

10/09/2006