BRIAN DAVID O'DONNELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****56

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

DAVID

Last Name

O'DONNELL

Business Name

BRIAN DAVID O'DONNELL

Original Issue Date

05/05/2015

Effective Date

02/20/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60602

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020