WAYNE S BLAKE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

ACTIVE

Business

First Name

WAYNE

Middle

Last Name

BLAKE

Suffix

Business Name

WAYNE S BLAKE DO

Original Issue Date

06/25/1996

Effective Date

06/05/2023

Expiration Date

07/31/2026

City

BOCA RATON

State

Zip

33498

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2023