MATTHEW RAY BENNETT Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005101

License Status

NOT RENEWED

Business

First Name

MATTHEW

Middle

RAY

Last Name

BENNETT

Business Name

MATTHEW RAY BENNETT

Original Issue Date

07/29/2014

Effective Date

07/29/2014

Expiration Date

03/01/2016

City

BELOIT

State

Zip

53511

Ever Disciplined

LastModifiedDate

10/27/2016