CHARLES T BLACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036074177

License Status

INACTIVE

Business

First Name

CHARLES T

Last Name

BLACK

Suffix

Business Name

CHARLES T BLACK MD

Original Issue Date

11/21/1986

Effective Date

11/21/1986

Expiration Date

07/31/1987

City

MALIBU

State

Zip

90265

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

09/20/2006