BLAINE LYNN ENDERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036063999

License Status

NOT RENEWED

Business

First Name

BLAINE LYNN

Last Name

ENDERSON

Suffix

Business Name

BLAINE LYNN ENDERSON MD

Original Issue Date

03/05/1982

Effective Date

03/05/1982

Expiration Date

07/31/1987

City

CHICAGO

State

Zip

60613

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006