JASON M LICHT Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002065

License Status

INACTIVE

Business

First Name

JASON

Middle

Last Name

LICHT

Business Name

JASON M LICHT

Original Issue Date

08/26/2003

Effective Date

08/26/2003

Expiration Date

03/01/2006

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/09/2006