DAVID EUGENE BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036057620

License Status

NOT RENEWED

Business

First Name

DAVID EUGENE

Last Name

BLACKWELL

Suffix

Business Name

DAVID EUGENE BLACKWELL MD

Original Issue Date

09/25/1978

Effective Date

09/25/1978

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006