COLIN MICHAEL BRODERICK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****38

License Status

ACTIVE

Business

First Name

COLIN

Middle

MICHAEL

Last Name

BRODERICK

Business Name

COLIN MICHAEL BRODERICK

Original Issue Date

07/20/2022

Effective Date

02/12/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/12/2026