KORY DANE BLANK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068544

License Status

CANCELLED

Business

Title

First Name

KORY

Middle

DANE

Last Name

BLANK

Business Name

KORY DANE BLANK MD

Original Issue Date

06/26/2019

Effective Date

06/26/2019

Expiration Date

06/25/2021

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

04/16/2019