GARY J FISK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****48

License Status

NOT RENEWED

Business

First Name

GARY

Middle

Last Name

FISK

Business Name

GARY J FISK

Original Issue Date

01/22/2002

Effective Date

02/24/2014

Expiration Date

03/01/2016

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

06/09/2016