ALLEN PETER BLACKMON - Physician Assistant License in Illinois | # 085000178

ALLEN PETER BLACKMON

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000178

License Status

NOT RENEWED

Business

N

First Name

ALLEN PETER

Last Name

BLACKMON

Business Name

ALLEN PETER BLACKMON

Original Issue Date

04/13/1978

Effective Date

04/13/1978

Expiration Date

03/01/2006

State

IL

Ever Disciplined

N

LastModifiedDate

10/09/2006