LESLEY M BLAKE MD - Medical Doctor License in Idaho | # 036070021

LESLEY M BLAKE MD

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036070021

License Status

INACTIVE

Business

N

First Name

LESLEY M

Last Name

BLAKE

Suffix

MD

Business Name

LESLEY M BLAKE MD

Original Issue Date

01/16/1985

Effective Date

01/16/1985

Expiration Date

07/31/2005

State

ID

Ever Disciplined

N

LastModifiedDate

10/09/2006