PHILLIP WAYNE BLAICH Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

INOPERATIVE

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

State

Ever Disciplined

LastModifiedDate

05/31/2017