GARY PHILLIP BULLARD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085002102

License Status

NOT RENEWED

Business

First Name

GARY

Middle

PHILLIP

Last Name

BULLARD

Business Name

GARY PHILLIP BULLARD

Original Issue Date

10/01/2003

Effective Date

10/01/2003

Expiration Date

03/01/2006

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

10/09/2006