MICHAEL LEROY MATTESON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****10

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

LEROY

Last Name

MATTESON

Business Name

MICHAEL LEROY MATTESON

Original Issue Date

03/19/2002

Effective Date

12/21/2011

Expiration Date

03/01/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

04/08/2014