LESLEY M BLAKE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036070021

License Status

INACTIVE

Business

First Name

LESLEY M

Last Name

BLAKE

Suffix

Business Name

LESLEY M BLAKE MD

Original Issue Date

01/16/1985

Effective Date

01/16/1985

Expiration Date

07/31/2005

City

HARRISON

State

Zip

83833

County

IDAHO

Ever Disciplined

LastModifiedDate

10/09/2006