BRADLEY MATTHEW WOLF Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****41

License Status

NOT RENEWED

Business

First Name

BRADLEY

Middle

MATTHEW

Last Name

WOLF

Business Name

BRADLEY MATTHEW WOLF

Original Issue Date

03/02/2007

Effective Date

01/09/2020

Expiration Date

03/01/2022

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022