LARA MARIA DAVIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001875

License Status

NOT RENEWED

Business

First Name

LARA

Middle

MARIA

Last Name

DAVIS

Business Name

LARA MARIA DAVIS

Original Issue Date

09/24/2002

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Ever Disciplined

LastModifiedDate

04/01/2010