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Licensing details for: A 198873

Name: Mathis, Michael Edward

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: Loma Linda University School of Medicine

Graduation Year: 2023

Address of Record

1705 Allison Way
REDLANDS CA 92373-7436
SAN BERNARDINO county
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Issuance Date

September 4, 2024

Expiration Date

November 30, 2026

Current Date / Time

April 3, 2026
5:21:37 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: Mathis, Michael Edward

License/Registration Type: Postgraduate Training License

License Number: 13567 Primary Status: License Canceled

Address :
4445 Magnolia Ave
RIVERSIDE CA 92501-4135
RIVERSIDE COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

No AB 133 Survey Information Provided by Licensee

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