NATHAN BLAZER LONG MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044899

License Status

EXPIRED

Business

First Name

NATHAN

Middle

BLAZER

Last Name

LONG

Suffix

Business Name

NATHAN BLAZER LONG MD

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

06/30/2003

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

09/22/2006