MICHAEL SCOTT BLOOM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032471

License Status

EXPIRED

Business

First Name

MICHAEL SCOTT

Last Name

BLOOM

Business Name

MICHAEL SCOTT BLOOM

Original Issue Date

05/09/1995

Effective Date

05/09/1995

Expiration Date

06/30/1998

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

09/22/2006