ELLEN R BLOOD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****55

License Status

NOT RENEWED

Business

First Name

ELLEN

Middle

Last Name

BLOOD

Business Name

ELLEN R BLOOD

Original Issue Date

05/29/2002

Effective Date

05/29/2002

Expiration Date

03/01/2008

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/26/2006