RICHARD L FASSOLA Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****07

License Status

INACTIVE

Business

First Name

RICHARD

Middle

Last Name

FASSOLA

Business Name

RICHARD L FASSOLA

Original Issue Date

03/14/2002

Effective Date

02/18/2022

Expiration Date

03/01/2024

City

BLOOMINGDALE

State

Zip

60108

County

DUPAGE

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/18/2022