WAYNE S BLAKE DO - Medical Doctor License in Illinois | # 125029952

WAYNE S BLAKE DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029952

License Status

EXPIRED

Business

N

First Name

WAYNE

Middle

S

Last Name

BLAKE

Suffix

DO

Business Name

WAYNE S BLAKE DO

Original Issue Date

05/28/1993

Effective Date

05/28/1993

Expiration Date

06/30/1996

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006