DONNA J BLAKE - Medical Doctor License in Illinois | # 125018584

DONNA J BLAKE

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125018584

License Status

EXPIRED

Business

N

First Name

DONNA

Middle

J

Last Name

BLAKE

Business Name

DONNA J BLAKE

Original Issue Date

06/13/1985

Effective Date

06/13/1985

Expiration Date

07/01/1988

State

IL

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

N

LastModifiedDate

09/22/2006