SCOTT D PETERSEN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000637

License Status

NOT RENEWED

Business

First Name

SCOTT

Middle

Last Name

PETERSEN

Business Name

SCOTT D PETERSEN

Original Issue Date

12/19/1994

Effective Date

09/08/2016

Expiration Date

03/01/2018

City

WESTLAKE

State

Zip

44145

Ever Disciplined

LastModifiedDate

05/10/2018