STEPHEN BLACKSTONE EDSTROM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053766

License Status

EXPIRED

Business

First Name

STEPHEN

Middle

BLACKSTONE

Last Name

EDSTROM

Suffix

Business Name

STEPHEN BLACKSTONE EDSTROM MD

Original Issue Date

07/01/2007

Effective Date

07/01/2007

Expiration Date

06/30/2010

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/08/2010