BLAKE ANTHONY COOPER - Medical Doctor License in Illinois | # 125035933

BLAKE ANTHONY COOPER

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035933

License Status

EXPIRED

Business

N

First Name

BLAKE ANTHONY

Last Name

COOPER

Business Name

BLAKE ANTHONY COOPER

Original Issue Date

05/12/1997

Effective Date

05/12/1997

Expiration Date

06/26/1998

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006