ROLAND C FULL 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

ROLAND

Middle

Last Name

FULL

Business Name

ROLAND C FULL

Original Issue Date

01/29/2001

Effective Date

01/29/2001

Expiration Date

03/01/2002

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

10/09/2006