TODD AARON STACK 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

TODD

Middle

AARON

Last Name

STACK

Business Name

TODD AARON STACK

Original Issue Date

04/30/2013

Effective Date

01/13/2014

Expiration Date

03/01/2016

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

07/02/2014