License Verification

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ERIC LANCE BRANDENBURG

License Number: PA9110259

Data As Of 5/20/2024

Profession
Physician Assistant
License
PA9110259
License Status
DELINQUENT/
Qualifications
Prescribing
Dispensing Practitioner
License Expiration Date
1/31/2024
License Original Issue Date
03/13/2017
Address of Record
3045 Columbia Blvd.
MedFast
TITUSVILLE, FL 32780
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
FORD, ROBERT CHARLES III Supervising Prescribing Practitioner Osteopathic Physician 12456 09/21/2017
MCPHERSON, JOHN RAMEY Supervising Prescribing Practitioner Medical Doctor 58708 09/21/2017
WILLIAMS, DAVID THOMAS Supervising Dispensing Practitioner Osteopathic Physician 6588 08/30/2018
WILLIAMS, DAVID THOMAS Supervising Prescribing Practitioner Osteopathic Physician 6588 08/29/2018

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 5/21/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.