BRIAN E BLACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036072336

License Status

INACTIVE

Business

First Name

BRIAN E

Last Name

BLACK

Suffix

Business Name

BRIAN E BLACK MD

Original Issue Date

02/20/1986

Effective Date

02/20/1986

Expiration Date

07/31/1996

City

MILWAUKEE

State

Zip

53215

County

WISCONSIN

Ever Disciplined

LastModifiedDate

01/09/2019