JORGE BLACKALLER MD - Medical Doctor License in Illinois | # 036037821

JORGE BLACKALLER MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036037821

License Status

NOT RENEWED

Business

N

First Name

JORGE

Last Name

BLACKALLER

Suffix

MD

Business Name

JORGE BLACKALLER MD

Original Issue Date

06/21/1962

Effective Date

05/26/2014

Expiration Date

07/31/2017

State

IL

Ever Disciplined

N

LastModifiedDate

11/01/2017