TIMOTHY LYNN BLACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000583

License Status

NOT RENEWED

Business

First Name

TIMOTHY LYNN

Last Name

BLACK

Business Name

TIMOTHY LYNN BLACK

Original Issue Date

02/01/1994

Effective Date

02/01/1994

Expiration Date

03/01/2004

City

SAINT LOUIS

State

Zip

63146

Ever Disciplined

LastModifiedDate

10/09/2006