TONY ALBERT FANTOZZI Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002329

License Status

INACTIVE

Business

First Name

TONY

Middle

ALBERT

Last Name

FANTOZZI

Business Name

TONY ALBERT FANTOZZI

Original Issue Date

09/10/2004

Effective Date

09/10/2004

Expiration Date

03/01/2006

City

MONMOUTH

State

Zip

61462

County

WARREN

Ever Disciplined

LastModifiedDate

10/09/2006