ALONSO BOLIVAR Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****79

License Status

ACTIVE

Business

First Name

ALONSO

Last Name

BOLIVAR

Business Name

ALONSO BOLIVAR

Original Issue Date

09/23/2025

Effective Date

01/07/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/07/2026