LUCAS ROTH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****64

License Status

ACTIVE

Business

First Name

LUCAS

Last Name

ROTH

Business Name

LUCAS ROTH

Original Issue Date

10/10/2017

Effective Date

02/03/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61614

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/03/2026