SCOTT DOUGLAS THOMPSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002436

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

DOUGLAS

Last Name

THOMPSON

Business Name

SCOTT DOUGLAS THOMPSON

Original Issue Date

12/13/2004

Effective Date

12/13/2004

Expiration Date

03/01/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/23/2008