BRYAN CLIFTON STOUT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

NOT RENEWED

Business

First Name

BRYAN

Middle

CLIFTON

Last Name

STOUT

Business Name

BRYAN CLIFTON STOUT

Original Issue Date

04/22/2011

Effective Date

02/21/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60649

County

COOK

Ever Disciplined

LastModifiedDate

04/08/2014