TIMOTHY LYNN BLACK - Physician Assistant License in Missouri | # 085000583

TIMOTHY LYNN BLACK

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000583

License Status

NOT RENEWED

Business

N

First Name

TIMOTHY LYNN

Last Name

BLACK

Business Name

TIMOTHY LYNN BLACK

Original Issue Date

02/01/1994

Effective Date

02/01/1994

Expiration Date

03/01/2004

State

MO

Ever Disciplined

N

LastModifiedDate

10/09/2006