STEVEN ANDREW TIDWELL Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****98

License Status

NOT RENEWED

Business

First Name

STEVEN

Middle

ANDREW

Last Name

TIDWELL

Business Name

STEVEN ANDREW TIDWELL

Original Issue Date

12/04/2018

Effective Date

12/04/2018

Expiration Date

03/01/2020

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/24/2020