JORGE BLACKALLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036037821

License Status

NOT RENEWED

Business

First Name

JORGE

Last Name

BLACKALLER

Suffix

Business Name

JORGE BLACKALLER MD

Original Issue Date

06/21/1962

Effective Date

05/26/2014

Expiration Date

07/31/2017

City

RIVERSIDE

State

Zip

60546

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017