MATT CHARLES ERICKSON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****15

License Status

INOPERATIVE

Business

First Name

MATT

Middle

CHARLES

Last Name

ERICKSON

Business Name

MATT CHARLES ERICKSON

Original Issue Date

10/12/2011

Effective Date

01/18/2012

Expiration Date

03/01/2014

City

SAINT CHARLES

State

Zip

60174

County

KANE

Ever Disciplined

LastModifiedDate

01/18/2012