ROBERT D BLANK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036094397

License Status

INACTIVE

Business

First Name

ROBERT

Middle

Last Name

BLANK

Suffix

Business Name

ROBERT D BLANK MD

Original Issue Date

10/21/1996

Effective Date

04/05/2011

Expiration Date

07/31/2014

City

MADISON

State

Zip

53705

County

WISCONSIN

Ever Disciplined

LastModifiedDate

04/08/2014