MARC EDWARD DICKLIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001427

License Status

NOT RENEWED

Business

First Name

MARC

Middle

EDWARD

Last Name

DICKLIN

Business Name

MARC EDWARD DICKLIN

Original Issue Date

09/28/2000

Effective Date

03/05/2014

Expiration Date

03/01/2016

City

VIOLA

State

Zip

61486

County

MERCER

Ever Disciplined

LastModifiedDate

04/25/2016