DALLAS WYOTT LIPSCOMB Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

NOT RENEWED

Business

First Name

DALLAS

Middle

WYOTT

Last Name

LIPSCOMB

Business Name

DALLAS WYOTT LIPSCOMB

Original Issue Date

03/09/2001

Effective Date

02/27/2012

Expiration Date

03/01/2014

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Ever Disciplined

LastModifiedDate

03/16/2015