TONY ALBERT FANTOZZI Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****03

License Status

NOT RENEWED

Business

First Name

TONY

Middle

ALBERT

Last Name

FANTOZZI

Business Name

TONY ALBERT FANTOZZI

Original Issue Date

12/09/2004

Effective Date

12/09/2004

Expiration Date

03/01/2006

City

MONMOUTH

State

Zip

61462

County

WARREN

Ever Disciplined

LastModifiedDate

09/26/2006