PERTH A BLAKE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125027979

License Status

EXPIRED

Business

First Name

PERTH

Middle

Last Name

BLAKE

Business Name

PERTH A BLAKE

Original Issue Date

05/08/1992

Effective Date

05/08/1992

Expiration Date

06/30/1995

City

HINSDALE

State

Zip

60521

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006