JUSTIN THOMAS BLACKMON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085005596

License Status

NOT RENEWED

Business

First Name

JUSTIN

Middle

THOMAS

Last Name

BLACKMON

Business Name

JUSTIN THOMAS BLACKMON

Original Issue Date

08/11/2015

Effective Date

02/19/2016

Expiration Date

03/01/2018

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

07/28/2025