TANNER ALEXANDER ISRAEL Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****76

License Status

ACTIVE

Business

First Name

TANNER

Middle

ALEXANDER

Last Name

ISRAEL

Business Name

TANNER ALEXANDER ISRAEL

Original Issue Date

12/19/2022

Effective Date

12/03/2025

Expiration Date

03/01/2028

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025