Ty Dallas Mangum

License

Licensed by

Illinois Department of Financial and Professional Regulation

License number

38*****05

Status

Expired (Not Renewed)

First issued

December 21, 2021

Expired

March 1, 2024

License holder

Ty Dallas Mangum

Entity type

Individual

Classifications

• Physician Assistant Controlled Substance Physicians & Surgeons

More from the license record

Delegated controlled substance schedules

II III IV V

Current term began

12/21/2021

Other Illinois licenses under this name

• IL
  Ty Dallas Mangum

  License 085008692

  Licensed Physician Assistant
  Expired

  Evanston, IL

  Expired Mar 1, 2024

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