BRIAN C DOUGLASS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****43

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

DOUGLASS

Business Name

BRIAN C DOUGLASS

Original Issue Date

08/16/2011

Effective Date

02/22/2012

Expiration Date

03/01/2014

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

02/05/2015