WILLIAM JOHN STOUT 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

WILLIAM

Middle

JOHN

Last Name

STOUT

Business Name

WILLIAM JOHN STOUT

Original Issue Date

08/16/2007

Effective Date

01/08/2010

Expiration Date

03/01/2012

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/16/2012