THOMAS HARDY MASSING Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****12

License Status

INOPERATIVE

Business

First Name

THOMAS

Middle

HARDY

Last Name

MASSING

Business Name

THOMAS HARDY MASSING

Original Issue Date

06/18/2004

Effective Date

04/24/2012

Expiration Date

03/01/2014

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/07/2013