JACOB LEE PATTY Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****75

License Status

INOPERATIVE

Business

First Name

JACOB

Middle

LEE

Last Name

PATTY

Business Name

JACOB LEE PATTY

Original Issue Date

10/20/2010

Effective Date

02/26/2018

Expiration Date

03/01/2020

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

12/18/2019