MATTHEW GARRISON BAKER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****88

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

GARRISON

Last Name

BAKER

Business Name

MATTHEW GARRISON BAKER

Original Issue Date

04/08/2004

Effective Date

02/24/2012

Expiration Date

03/01/2014

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

03/20/2014