TAYLOR MARIE BOGUE Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****40

License Status

INOPERATIVE

Business

First Name

TAYLOR

Middle

MARIE

Last Name

BOGUE

Business Name

TAYLOR MARIE BOGUE

Original Issue Date

05/16/2019

Effective Date

02/04/2022

Expiration Date

03/01/2024

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

02/22/2024