MARC EDWARD DICKLIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****02

License Status

NOT RENEWED

Business

First Name

MARC

Middle

EDWARD

Last Name

DICKLIN

Business Name

MARC EDWARD DICKLIN

Original Issue Date

05/18/2001

Effective Date

03/13/2014

Expiration Date

03/01/2016

City

ALEDO

State

Zip

61231

County

MERCER

Ever Disciplined

LastModifiedDate

04/25/2016