MATT CHARLES ERICKSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004143

License Status

NOT RENEWED

Business

First Name

MATT

Middle

CHARLES

Last Name

ERICKSON

Business Name

MATT CHARLES ERICKSON

Original Issue Date

09/20/2011

Effective Date

01/18/2012

Expiration Date

03/01/2014

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/08/2014