RUSSELL ALAN JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005781

License Status

NOT RENEWED

Business

First Name

RUSSELL

Middle

ALAN

Last Name

JOHNSON

Business Name

RUSSELL ALAN JOHNSON

Original Issue Date

02/19/2016

Effective Date

02/23/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60654

County

COOK

Ever Disciplined

LastModifiedDate

11/24/2020