TIMOTHY E BLACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036075965

License Status

INACTIVE

Business

First Name

TIMOTHY E

Last Name

BLACK

Suffix

Business Name

TIMOTHY E BLACK MD

Original Issue Date

09/15/1987

Effective Date

09/15/1987

Expiration Date

07/31/1990

City

PHOENIX

State

Zip

85014

County

ARIZONA

Ever Disciplined

LastModifiedDate

09/20/2006