BLAKE D ALEXANDER - Medical Doctor License in Illinois | # 125032542

BLAKE D ALEXANDER

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032542

License Status

EXPIRED

Business

N

First Name

BLAKE

Middle

D

Last Name

ALEXANDER

Business Name

BLAKE D ALEXANDER

Original Issue Date

05/15/1995

Effective Date

05/15/1995

Expiration Date

06/30/1998

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006