RUSSELL W BROWN II 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

RUSSELL

Middle

Last Name

BROWN

Suffix

Business Name

RUSSELL W BROWN II

Original Issue Date

09/23/2004

Effective Date

02/04/2020

Expiration Date

03/01/2022

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

01/03/2022