COREY A BLACK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036103860

License Status

NOT RENEWED

Business

First Name

COREY

Middle

Last Name

BLACK

Business Name

COREY A BLACK

Original Issue Date

11/29/2000

Effective Date

06/11/2020

Expiration Date

07/31/2023

City

MOUNT VERNON

State

Zip

62864

County

MCHENRY

Ever Disciplined

LastModifiedDate

11/30/2023