MATTHEW ROBERT GREEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003641

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

ROBERT

Last Name

GREEN

Business Name

MATTHEW ROBERT GREEN

Original Issue Date

10/09/2009

Effective Date

01/22/2010

Expiration Date

03/01/2012

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

04/11/2012