EASTON IZAAK MANN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****77

License Status

NOT RENEWED

Business

First Name

EASTON

Middle

IZAAK

Last Name

MANN

Business Name

EASTON IZAAK MANN

Original Issue Date

07/13/2019

Effective Date

12/30/2019

Expiration Date

03/01/2022

City

BELLEVILLE

State

Zip

62223

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022