JEFFREY R BERGQUIST Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****26

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

Last Name

BERGQUIST

Business Name

JEFFREY R BERGQUIST

Original Issue Date

06/13/2001

Effective Date

06/13/2001

Expiration Date

03/01/2006

City

WAUKEGAN

State

Zip

60085

County

LAKE

Ever Disciplined

LastModifiedDate

09/26/2006