DALLAS WYOTT LIPSCOMB Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001343

License Status

NOT RENEWED

Business

First Name

DALLAS

Middle

WYOTT

Last Name

LIPSCOMB

Business Name

DALLAS WYOTT LIPSCOMB

Original Issue Date

01/18/2000

Effective Date

02/27/2012

Expiration Date

03/01/2014

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Ever Disciplined

LastModifiedDate

03/16/2015