JUSTIN THOMAS BLACKMON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****39

License Status

NOT RENEWED

Business

First Name

JUSTIN

Middle

THOMAS

Last Name

BLACKMON

Business Name

JUSTIN THOMAS BLACKMON

Original Issue Date

12/28/2015

Effective Date

12/28/2015

Expiration Date

03/01/2018

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2018