BRENT L CARD Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****86

License Status

INOPERATIVE

Business

First Name

BRENT

Middle

Last Name

CARD

Business Name

BRENT L CARD

Original Issue Date

10/31/2003

Effective Date

02/11/2014

Expiration Date

03/01/2016

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

07/02/2014