SCOTT BLAINE DO - Medical Doctor License in Illinois | # 130001400

SCOTT BLAINE DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001400

License Status

EXPIRED

Business

N

Title

DO

First Name

SCOTT

Last Name

BLAINE

Business Name

SCOTT BLAINE DO

Original Issue Date

06/28/2021

Effective Date

06/28/2021

Expiration Date

12/27/2021

State

IL

Specialty/Qualifier

Anesthesiology

Ever Disciplined

N

LastModifiedDate

10/11/2022