LARRY ERNEST GERDOM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****00

License Status

ACTIVE

Business

First Name

LARRY

Middle

ERNEST

Last Name

GERDOM

Business Name

LARRY ERNEST GERDOM

Original Issue Date

07/19/2013

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

CISSNA PARK

State

Zip

60924

County

IROQUOIS

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025