LORA ANN ROACH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001793

License Status

NOT RENEWED

Business

First Name

LORA

Middle

ANN

Last Name

ROACH

Business Name

LORA ANN ROACH

Original Issue Date

05/01/2002

Effective Date

05/01/2002

Expiration Date

03/01/2004

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/09/2006