DAPHENE SMITH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****90

License Status

NOT RENEWED

Business

First Name

DAPHENE

Last Name

SMITH

Business Name

DAPHENE SMITH

Original Issue Date

06/26/2007

Effective Date

02/22/2018

Expiration Date

03/01/2020

City

WASHINGTON PK

State

Zip

62204

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020