BRIAN R KODISH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003702

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

KODISH

Business Name

BRIAN R KODISH

Original Issue Date

02/18/2010

Effective Date

01/21/2016

Expiration Date

03/01/2018

City

MASCOUTAH

State

Zip

62258

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

05/10/2018