BENJAMIN KEITH MATTOX Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004596

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

KEITH

Last Name

MATTOX

Business Name

BENJAMIN KEITH MATTOX

Original Issue Date

01/03/2013

Effective Date

03/10/2014

Expiration Date

03/01/2016

City

GREAT LAKES

State

Zip

60088

County

LAKE

Ever Disciplined

LastModifiedDate

04/25/2016