BLAINE L FARLESS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020750

License Status

EXPIRED

Business

First Name

BLAINE L

Last Name

FARLESS

Business Name

BLAINE L FARLESS

Original Issue Date

05/08/1987

Effective Date

05/08/1987

Expiration Date

07/01/1990

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

09/22/2006