BRIAN C DOUGLASS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004083

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

DOUGLASS

Business Name

BRIAN C DOUGLASS

Original Issue Date

07/20/2011

Effective Date

02/22/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

02/05/2015