BRITTANY NOEL BLAISE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070050

License Status

CANCELLED

Business

Title

First Name

BRITTANY

Middle

NOEL

Last Name

BLAISE

Business Name

BRITTANY NOEL BLAISE MD

Original Issue Date

06/25/2020

Effective Date

06/25/2020

Expiration Date

06/26/2021

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

02/11/2020