BENJAMIN JACOB ROTH Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****80

License Status

ACTIVE

Business

First Name

BENJAMIN

Middle

JACOB

Last Name

ROTH

Business Name

BENJAMIN JACOB ROTH

Original Issue Date

08/15/2016

Effective Date

02/03/2026

Expiration Date

03/01/2028

City

DOWNERS GROVE

State

Zip

60516

County

DUPAGE

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/03/2026