CARLEY A PUTNAM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****97

License Status

NOT RENEWED

Business

First Name

CARLEY

Middle

Last Name

PUTNAM

Business Name

CARLEY A PUTNAM

Original Issue Date

10/30/2017

Effective Date

02/20/2018

Expiration Date

03/01/2020

City

HARVEY

State

Zip

60426

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020