BRANDEN LEE MOSSMAN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****96

License Status

NOT RENEWED

Business

First Name

BRANDEN

Middle

LEE

Last Name

MOSSMAN

Business Name

BRANDEN LEE MOSSMAN

Original Issue Date

07/26/2019

Effective Date

01/29/2022

Expiration Date

03/01/2024

City

MORTON GROVE

State

Zip

60053

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025