SIMON FARID MIZYED Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****78

License Status

NOT RENEWED

Business

First Name

SIMON

Middle

FARID

Last Name

MIZYED

Business Name

SIMON FARID MIZYED

Original Issue Date

12/31/2002

Effective Date

12/31/2002

Expiration Date

03/01/2008

City

PEORIA

State

Zip

61605

County

PEORIA

Ever Disciplined

LastModifiedDate

09/26/2006