LOIS M DISHMAN-COOPER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****44

License Status

NOT RENEWED

Business

First Name

LOIS

Middle

Last Name

DISHMAN-COOPER

Business Name

LOIS M DISHMAN-COOPER

Original Issue Date

03/05/2007

Effective Date

01/21/2020

Expiration Date

03/01/2022

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022