BLAKE BAILEY ANDERSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059643

License Status

CANCELLED

Business

Title

First Name

BLAKE

Middle

BAILEY

Last Name

ANDERSON

Business Name

BLAKE BAILEY ANDERSON MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2014

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

03/27/2012