KEVIN THOMAS WYNE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****86

License Status

NOT RENEWED

Business

First Name

KEVIN

Middle

THOMAS

Last Name

WYNE

Business Name

KEVIN THOMAS WYNE

Original Issue Date

09/23/2005

Effective Date

09/23/2005

Expiration Date

03/01/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/26/2006