CHARLES R BLAKE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043276

License Status

EXPIRED

Business

First Name

CHARLES

Middle

Last Name

BLAKE

Suffix

Business Name

CHARLES R BLAKE MD

Original Issue Date

07/01/2001

Effective Date

07/01/2001

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

09/22/2006