TYLER KEITH JOHNSON 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

TYLER

Middle

KEITH

Last Name

JOHNSON

Business Name

TYLER KEITH JOHNSON

Original Issue Date

09/21/2016

Effective Date

02/21/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60611

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020