MATTHEW ROBERT GREEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****13

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

ROBERT

Last Name

GREEN

Business Name

MATTHEW ROBERT GREEN

Original Issue Date

11/05/2009

Effective Date

01/22/2010

Expiration Date

03/01/2012

City

EVANSTON

State

Zip

60202

County

COOK

Ever Disciplined

LastModifiedDate

04/16/2012