BRIAN R KODISH Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****26

License Status

INOPERATIVE

Business

First Name

BRIAN

Middle

Last Name

KODISH

Business Name

BRIAN R KODISH

Original Issue Date

04/14/2010

Effective Date

02/26/2016

Expiration Date

03/01/2018

City

ALTON

State

Zip

62002

County

MADISON

Ever Disciplined

LastModifiedDate

05/02/2018