JORDAN MAREE FRYE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085007308

License Status

NOT RENEWED

Business

First Name

JORDAN

Middle

MAREE

Last Name

FRYE

Business Name

JORDAN MAREE FRYE

Original Issue Date

09/26/2019

Effective Date

09/26/2019

Expiration Date

03/01/2020

City

STAUNTON

State

Zip

62088

County

MACOUPIN

Ever Disciplined

LastModifiedDate

11/24/2020