MATTHEW RAY BENNETT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****34

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

RAY

Last Name

BENNETT

Business Name

MATTHEW RAY BENNETT

Original Issue Date

07/29/2014

Effective Date

07/29/2014

Expiration Date

03/01/2016

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/27/2016