BRIAN E BLACK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125017026

License Status

EXPIRED

Business

First Name

BRIAN E

Last Name

BLACK

Suffix

Business Name

BRIAN E BLACK MD

Original Issue Date

06/22/1984

Effective Date

06/22/1984

Expiration Date

07/01/1986

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

09/22/2006