REGAN RUSS MILLER Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****17

License Status

INOPERATIVE

Business

First Name

REGAN

Middle

RUSS

Last Name

MILLER

Business Name

REGAN RUSS MILLER

Original Issue Date

09/09/2014

Effective Date

09/09/2014

Expiration Date

03/01/2016

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

07/06/2015