STEPHANIE MICHELLE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108390

License Status

NOT RENEWED

Business

First Name

STEPHANIE

Middle

MICHELLE

Last Name

BLACK

Suffix

Business Name

STEPHANIE MICHELLE BLACK MD

Original Issue Date

01/03/2003

Effective Date

01/03/2003

Expiration Date

07/31/2005

City

UNIVERSITY CITY

State

Zip

63130

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/09/2006