BRANDY LADORA MACON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006152

License Status

NOT RENEWED

Business

First Name

BRANDY

Middle

LADORA

Last Name

MACON

Business Name

BRANDY LADORA MACON

Original Issue Date

03/14/2017

Effective Date

01/12/2022

Expiration Date

03/01/2024

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

02/05/2025