License holder summary

JESTUS GRACEVILLA SAM is a Physicians Assistants - Physician Assistant Temporary licensed to practice in Michigan. This medical licensee license is not current. The license was granted 05/15/2012 and expired on 11/15/2013.

Department of Licensing and Regulatory Affairs

Board of Medicine

JESTUS GRACEVILLA SAM
Physicians Assistants - Physician Assistant Temporary
License number
5601006356
Date granted
05/15/2012
Date expires
11/15/2013
Class
Physicians Assistants - Physician Assistant Temporary
Status
Voided
Address
michiganmedical.net
ID 39315471
LAST UPDATED 2024-04-10 15:01:55 UTC

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