TIMOTHY WARREN PETERSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003932

License Status

NOT RENEWED

Business

First Name

TIMOTHY

Middle

WARREN

Last Name

PETERSON

Business Name

TIMOTHY WARREN PETERSON

Original Issue Date

10/07/2010

Effective Date

02/16/2012

Expiration Date

03/01/2014

City

OTTAWA

State

Zip

61350

County

LA SALLE

Ever Disciplined

LastModifiedDate

04/08/2014