BLAKE CONLEY RODGERS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051906

License Status

CANCELLED

Business

First Name

BLAKE

Middle

CONLEY

Last Name

RODGERS

Suffix

Business Name

BLAKE CONLEY RODGERS MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006