MOLLY DIANNE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036123359

License Status

NOT RENEWED

Business

Title

First Name

MOLLY

Middle

DIANNE

Last Name

BLACK

Business Name

MOLLY DIANNE BLACK MD

Original Issue Date

05/05/2009

Effective Date

05/05/2009

Expiration Date

07/31/2011

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

11/14/2011