PHILLIP WAYNE BLAICH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003348

License Status

NOT RENEWED

Business

First Name

PHILLIP

Middle

WAYNE

Last Name

BLAICH

Business Name

PHILLIP WAYNE BLAICH

Original Issue Date

10/07/2008

Effective Date

01/09/2012

Expiration Date

03/01/2014

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Ever Disciplined

LastModifiedDate

05/31/2017