DAMARIS A AGE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

INOPERATIVE

Business

First Name

DAMARIS

Middle

Last Name

AGE

Business Name

DAMARIS A AGE

Original Issue Date

02/04/2013

Effective Date

03/01/2016

Expiration Date

03/01/2018

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

05/02/2018