ALLEN PETER BLACKMON Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****90

License Status

NOT RENEWED

Business

First Name

ALLEN PETER

Last Name

BLACKMON

Business Name

ALLEN PETER BLACKMON

Original Issue Date

03/08/2001

Effective Date

03/08/2001

Expiration Date

03/01/2006

City

BLOOMINGDALE

State

Zip

60108

County

DUPAGE

Ever Disciplined

LastModifiedDate

10/09/2006