ROBERT D BLANK MD - Medical Doctor License in Wisconsin | # 036094397

ROBERT D BLANK MD

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036094397

License Status

INACTIVE

Business

N

First Name

ROBERT

Middle

D

Last Name

BLANK

Suffix

MD

Business Name

ROBERT D BLANK MD

Original Issue Date

10/21/1996

Effective Date

04/05/2011

Expiration Date

07/31/2014

State

WI

Ever Disciplined

N

LastModifiedDate

04/08/2014