ROBERT DYLAN MANGRUM Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085001757

License Status

INACTIVE

Business

First Name

ROBERT

Middle

DYLAN

Last Name

MANGRUM

Business Name

ROBERT DYLAN MANGRUM

Original Issue Date

01/24/2002

Effective Date

01/24/2002

Expiration Date

03/01/2006

City

CRESTWOOD

State

Zip

63126

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/09/2006