SAMANTHA ERIN BLANK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

Title

First Name

SAMANTHA

Middle

ERIN

Last Name

BLANK

Business Name

SAMANTHA ERIN BLANK MD

Original Issue Date

08/03/2019

Effective Date

08/03/2019

Expiration Date

09/30/2020

City

DENVER

State

Zip

80220

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021