MORGAN C BLAKE DO - Medical Doctor License in Illinois | # 125077532

MORGAN C BLAKE DO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077532

License Status

CANCELLED

Business

N

Title

DO

First Name

MORGAN

Middle

C

Last Name

BLAKE

Business Name

MORGAN C BLAKE DO

Original Issue Date

06/24/2021

Effective Date

06/24/2021

Expiration Date

06/23/2024

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

04/02/2021