ASHLEY GALE BLACK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058851

License Status

CANCELLED

Business

Title

First Name

ASHLEY

Middle

GALE

Last Name

BLACK

Business Name

ASHLEY GALE BLACK DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/13/2010