GARY PHILLIP BULLARD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****17

License Status

NOT RENEWED

Business

First Name

GARY

Middle

PHILLIP

Last Name

BULLARD

Business Name

GARY PHILLIP BULLARD

Original Issue Date

12/05/2003

Effective Date

12/05/2003

Expiration Date

03/01/2006

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

10/09/2006