ROBERT DYLAN MANGRUM Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****89

License Status

NOT RENEWED

Business

First Name

ROBERT

Middle

DYLAN

Last Name

MANGRUM

Business Name

ROBERT DYLAN MANGRUM

Original Issue Date

02/25/2002

Effective Date

02/25/2002

Expiration Date

03/01/2006

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

09/26/2006