ELIZABETH GRACE BLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036146792

License Status

NOT RENEWED

Business

Title

First Name

ELIZABETH

Middle

GRACE

Last Name

BLACK

Business Name

ELIZABETH GRACE BLACK MD

Original Issue Date

07/05/2018

Effective Date

08/03/2020

Expiration Date

07/31/2023

City

ROLLA

State

Zip

65401

Ever Disciplined

LastModifiedDate

11/30/2023