ZACHARY R GUSTAVISON Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****05

License Status

ACTIVE

Business

First Name

ZACHARY

Middle

Last Name

GUSTAVISON

Business Name

ZACHARY R GUSTAVISON

Original Issue Date

11/03/2010

Effective Date

12/24/2025

Expiration Date

03/01/2028

City

MARION

State

Zip

62959

County

JEFFERSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/24/2025