LEIGH DIANE ROTH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****62

License Status

NOT RENEWED

Business

First Name

LEIGH

Middle

DIANE

Last Name

ROTH

Business Name

LEIGH DIANE ROTH

Original Issue Date

07/06/2010

Effective Date

02/26/2014

Expiration Date

03/01/2016

City

DEERFIELD

State

Zip

60015

County

LAKE

Ever Disciplined

LastModifiedDate

04/25/2016