GLENN ADAM PETERSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085006213

License Status

NOT RENEWED

Business

First Name

GLENN

Middle

ADAM

Last Name

PETERSON

Business Name

GLENN ADAM PETERSON

Original Issue Date

06/22/2017

Effective Date

02/13/2020

Expiration Date

03/01/2022

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

07/27/2022