DAVID EUGENE BLACKWELL MD - Medical Doctor License in Illinois | # 036057620

DAVID EUGENE BLACKWELL MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036057620

License Status

NOT RENEWED

Business

N

First Name

DAVID EUGENE

Last Name

BLACKWELL

Suffix

MD

Business Name

DAVID EUGENE BLACKWELL MD

Original Issue Date

09/25/1978

Effective Date

09/25/1978

Expiration Date

07/31/2005

State

IL

Ever Disciplined

N

LastModifiedDate

10/09/2006