RUSSELL ALAN JOHNSON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****69

License Status

NOT RENEWED

Business

First Name

RUSSELL

Middle

ALAN

Last Name

JOHNSON

Business Name

RUSSELL ALAN JOHNSON

Original Issue Date

02/19/2016

Effective Date

02/23/2018

Expiration Date

03/01/2020

City

CHICAGO

State

Zip

60618

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020