JARED LUKE THATCHER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****09

License Status

NOT RENEWED

Business

First Name

JARED

Middle

LUKE

Last Name

THATCHER

Business Name

JARED LUKE THATCHER

Original Issue Date

06/02/2011

Effective Date

02/09/2012

Expiration Date

03/01/2014

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/29/2015