ELLIS JON THOMPSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****11

License Status

NOT RENEWED

Business

First Name

ELLIS

Middle

JON

Last Name

THOMPSON

Business Name

ELLIS JON THOMPSON

Original Issue Date

09/04/2014

Effective Date

02/22/2018

Expiration Date

03/01/2020

City

CARBONDALE

State

Zip

62901

County

JACKSON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020