LEIGH DIANE ROTH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003735

License Status

NOT RENEWED

Business

First Name

LEIGH

Middle

DIANE

Last Name

ROTH

Business Name

LEIGH DIANE ROTH

Original Issue Date

06/01/2010

Effective Date

02/26/2014

Expiration Date

03/01/2016

City

DEERFIELD

State

Zip

60015

County

LAKE

Ever Disciplined

LastModifiedDate

04/25/2016