JASON THEODORE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085009460

License Status

NOT RENEWED

Business

First Name

JASON

Last Name

THEODORE

Business Name

JASON THEODORE

Original Issue Date

12/17/2022

Effective Date

12/17/2022

Expiration Date

03/01/2024

City

WINSTON SALEM

State

Zip

27103

Ever Disciplined

LastModifiedDate

02/05/2025