GLENN ADAM PETERSON Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****47

License Status

INOPERATIVE

Business

First Name

GLENN

Middle

ADAM

Last Name

PETERSON

Business Name

GLENN ADAM PETERSON

Original Issue Date

06/27/2017

Effective Date

02/13/2020

Expiration Date

03/01/2022

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

01/03/2022