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Physician Last Name Physician First Name Physician Middle Name License Number License Type Effective Date Date Updated Year of Birth
Hershberger Marion Elizabeth 004170 PA 06/17/2019 06/17/2019 1967
Olander Marion Elizabeth 004170 PA 06/17/2019 06/17/2019 1967
Cooley Candace S. 210004 MD 06/18/2019 06/17/2019 1968
Blatti George M. 126420 MD 06/24/2019 06/17/2019 1945
Booth Joseph C. 175678 MD 06/14/2019 06/17/2019 1951
Mendez Leovares 215509 MD 06/24/2019 06/17/2019 1965
Denier James M. 215289 MD 06/14/2019 06/14/2019 1953
Cabantog Alberto M. 283064 MD 06/20/2019 06/13/2019 1959
Tesher Martin S. 170832 MD 06/19/2019 06/12/2019 1935
Smith Mark Jonathan 202871 MD 06/19/2019 06/12/2019 1952
Craig Gazelle 252279 DO 05/20/2019 06/11/2019 1976
Babayants Alexander R. 218269 MD 05/22/2019 06/07/2019 1955
Hardi Robert 155030 MD 06/14/2019 06/07/2019 1947
Monsour Roy C. 157561 MD 06/14/2019 06/07/2019 1954
Defreitas Ingrid 010128 PA 06/14/2019 06/07/2019 1982
Molden Gregory L. 164034 MD 06/06/2019 06/04/2019 1955
Anwar Romilla 195639 MD 06/04/2019 06/04/2019 1961
Antoine Ewald J. 167153 MD 06/06/2019 06/04/2019 1950
Ariyarajah Vignendra 268773 MD 05/24/2019 06/03/2019 1973
Martin William S. 167465 MD 06/10/2019 06/03/2019 1959
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