MATTHEW GARRISON BAKER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002208

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

GARRISON

Last Name

BAKER

Business Name

MATTHEW GARRISON BAKER

Original Issue Date

02/10/2004

Effective Date

02/24/2012

Expiration Date

03/01/2014

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

04/08/2014