The holder whose full name is LONG, DOUGLAS W,come from Mishawaka IN,hold the Physician Assistant license(NO.10000512A) which status is Expired.
| Name | LONG, DOUGLAS W |
|---|---|
| License Number | 10000512A |
| License Type | Physician Assistant |
| License Status | Expired |
| City | Mishawaka |
| State | IN |