SANTOS MICHAEL RIVERA Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004585

License Status

NOT RENEWED

Business

First Name

SANTOS

Middle

MICHAEL

Last Name

RIVERA

Business Name

SANTOS MICHAEL RIVERA

Original Issue Date

12/12/2012

Effective Date

03/02/2018

Expiration Date

03/01/2020

City

ROCKFORD

State

Zip

61101

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

11/24/2020