ELIZABETH B BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036064008

License Status

NOT RENEWED

Business

First Name

ELIZABETH B

Last Name

BLACK

Suffix

Business Name

ELIZABETH B BLACK MD

Original Issue Date

03/04/1982

Effective Date

04/08/2011

Expiration Date

07/31/2014

City

INDIANAPOLIS

State

Zip

46208

County

INDIANA

Ever Disciplined

LastModifiedDate

11/17/2014