JACOB LEE PATTY Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003896

License Status

NOT RENEWED

Business

First Name

JACOB

Middle

LEE

Last Name

PATTY

Business Name

JACOB LEE PATTY

Original Issue Date

09/24/2010

Effective Date

02/26/2018

Expiration Date

03/01/2020

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

11/24/2020