ALLEN PETER BLACKMON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000178

License Status

NOT RENEWED

Business

First Name

ALLEN PETER

Last Name

BLACKMON

Business Name

ALLEN PETER BLACKMON

Original Issue Date

04/13/1978

Effective Date

04/13/1978

Expiration Date

03/01/2006

City

BLOOMINGDALE

State

Zip

60108

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006