ROBERT DYLAN MANGRUM - Physician Assistant License in Missouri | # 085001757

ROBERT DYLAN MANGRUM

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001757

License Status

INACTIVE

Business

N

First Name

ROBERT

Middle

DYLAN

Last Name

MANGRUM

Business Name

ROBERT DYLAN MANGRUM

Original Issue Date

01/24/2002

Effective Date

01/24/2002

Expiration Date

03/01/2006

State

MO

Ever Disciplined

N

LastModifiedDate

10/09/2006