GARY W SLATER 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

GARY W

Last Name

SLATER

Business Name

GARY W SLATER

Original Issue Date

09/26/2013

Effective Date

02/26/2018

Expiration Date

03/01/2020

City

MAHOMET

State

Zip

61853

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020