TIMOTHY WARREN PETERSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****29

License Status

NOT RENEWED

Business

First Name

TIMOTHY

Middle

WARREN

Last Name

PETERSON

Business Name

TIMOTHY WARREN PETERSON

Original Issue Date

11/30/2010

Effective Date

02/16/2012

Expiration Date

03/01/2014

City

OTTAWA

State

Zip

61350

County

LA SALLE

Ever Disciplined

LastModifiedDate

04/08/2014