PERTH A BLAKE - Medical Doctor License in Illinois | # 125027979

PERTH A BLAKE

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125027979

License Status

EXPIRED

Business

N

First Name

PERTH

Middle

A

Last Name

BLAKE

Business Name

PERTH A BLAKE

Original Issue Date

05/08/1992

Effective Date

05/08/1992

Expiration Date

06/30/1995

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006