MARCUS ALAN ROMAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****72

License Status

NOT RENEWED

Business

First Name

MARCUS

Middle

ALAN

Last Name

ROMAN

Business Name

MARCUS ALAN ROMAN

Original Issue Date

10/16/2003

Effective Date

02/13/2020

Expiration Date

03/01/2022

City

DUNLAP

State

Zip

61525

County

PEORIA

Ever Disciplined

LastModifiedDate

07/27/2022