ROLAND WILLIBY JR MD Physician Assistant License verification

Business Entity

CANCELLED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****48

License Status

CANCELLED

Business

Title

First Name

ROLAND

Last Name

WILLIBY

Suffix

Business Name

ROLAND WILLIBY JR MD

Original Issue Date

05/13/2002

Effective Date

05/13/2002

Expiration Date

03/01/2008

City

HANOVER PARK

State

Zip

60133

County

DUPAGE

Ever Disciplined

LastModifiedDate

09/03/2009