CARLOS D LOPEZ Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****39

License Status

NOT RENEWED

Business

First Name

CARLOS

Middle

Last Name

LOPEZ

Business Name

CARLOS D LOPEZ

Original Issue Date

08/08/2012

Effective Date

08/08/2012

Expiration Date

03/01/2014

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/08/2014