SAMUEL JOHN SPENCER Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004397

License Status

NOT RENEWED

Business

First Name

SAMUEL

Middle

JOHN

Last Name

SPENCER

Business Name

SAMUEL JOHN SPENCER

Original Issue Date

08/08/2012

Effective Date

08/08/2012

Expiration Date

03/01/2014

City

WAUKESHA

State

Zip

53186

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/08/2014