BENJAMIN LEE STEVENS Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005352

License Status

INACTIVE

Business

First Name

BENJAMIN

Middle

LEE

Last Name

STEVENS

Business Name

BENJAMIN LEE STEVENS

Original Issue Date

11/12/2014

Effective Date

11/12/2014

Expiration Date

03/01/2016

City

FORT WAYNE

State

Zip

46814

County

INDIANA

Ever Disciplined

LastModifiedDate

01/25/2017