SIMON FARID MIZYED Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001799

License Status

NOT RENEWED

Business

First Name

SIMON

Middle

FARID

Last Name

MIZYED

Business Name

SIMON FARID MIZYED

Original Issue Date

06/05/2002

Effective Date

06/05/2002

Expiration Date

03/01/2008

City

WASHINGTON

State

Zip

61571

County

TAZEWELL

Ever Disciplined

LastModifiedDate

04/23/2008