BENJAMIN KEITH MATTOX Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

KEITH

Last Name

MATTOX

Business Name

BENJAMIN KEITH MATTOX

Original Issue Date

12/01/2014

Effective Date

12/01/2014

Expiration Date

03/01/2016

City

GREAT LAKES

State

Zip

60088

County

LAKE

Ever Disciplined

LastModifiedDate

04/25/2016