ANNE MARIE BRIDEGROOM Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****04

License Status

ACTIVE

Business

First Name

ANNE

Middle

MARIE

Last Name

BRIDEGROOM

Business Name

ANNE MARIE BRIDEGROOM

Original Issue Date

08/20/2024

Effective Date

08/20/2024

Expiration Date

03/01/2026

City

GRANITE CITY

State

Zip

62040

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025