TIMOTHY A BLAIN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034077

License Status

EXPIRED

Business

First Name

TIMOTHY

Middle

Last Name

BLAIN

Business Name

TIMOTHY A BLAIN

Original Issue Date

05/02/1996

Effective Date

05/02/1996

Expiration Date

06/30/1999

City

PEORIA

State

Zip

61637

County

PEORIA

Ever Disciplined

LastModifiedDate

09/22/2006