BLAIR ANTHONY MALENCH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****23

License Status

NOT RENEWED

Business

First Name

BLAIR

Middle

ANTHONY

Last Name

MALENCH

Business Name

BLAIR ANTHONY MALENCH

Original Issue Date

07/08/2021

Effective Date

01/28/2022

Expiration Date

03/01/2024

City

MARYVILLE

State

Zip

62062

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025