CARRIE ANNE ROG Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001508

License Status

NOT RENEWED

Business

First Name

CARRIE

Middle

ANNE

Last Name

ROG

Business Name

CARRIE ANNE ROG

Original Issue Date

12/05/2000

Effective Date

12/05/2000

Expiration Date

03/01/2002

City

LAKEWOOD

State

Zip

44107

County

OHIO

Ever Disciplined

LastModifiedDate

10/09/2006