VELMA E MATA Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002144

License Status

INACTIVE

Business

First Name

VELMA

Middle

Last Name

MATA

Business Name

VELMA E MATA

Original Issue Date

10/22/2003

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

SAINT LOUIS

State

Zip

63128

Ever Disciplined

LastModifiedDate

02/11/2010