SCOTT D PETERSEN 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

SCOTT

Middle

Last Name

PETERSEN

Business Name

SCOTT D PETERSEN

Original Issue Date

02/27/2002

Effective Date

02/27/2002

Expiration Date

03/01/2006

City

MARION

State

Zip

62959

County

WILLIAMSON

Ever Disciplined

LastModifiedDate

10/09/2006