BLAKE ANTHONY COOPER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035933

License Status

EXPIRED

Business

First Name

BLAKE ANTHONY

Last Name

COOPER

Business Name

BLAKE ANTHONY COOPER

Original Issue Date

05/12/1997

Effective Date

05/12/1997

Expiration Date

06/26/1998

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006