RANDALL LANE WILCOXEN Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****85

License Status

INOPERATIVE

Business

First Name

RANDALL

Middle

LANE

Last Name

WILCOXEN

Business Name

RANDALL LANE WILCOXEN

Original Issue Date

03/07/2001

Effective Date

02/05/2016

Expiration Date

03/01/2018

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

05/02/2018