GREGORY W BLANK - Physician Assistant License in Illinois | # 085002018

GREGORY W BLANK

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002018

License Status

INACTIVE

Business

N

First Name

GREGORY

Middle

W

Last Name

BLANK

Business Name

GREGORY W BLANK

Original Issue Date

07/02/2003

Effective Date

07/02/2003

Expiration Date

03/01/2006

State

IL

Ever Disciplined

N

LastModifiedDate

10/09/2006