JERAD DIAZ Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****47

License Status

ACTIVE

Business

First Name

JERAD

Last Name

DIAZ

Business Name

JERAD DIAZ

Original Issue Date

01/08/2024

Effective Date

01/08/2024

Expiration Date

03/01/2026

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025