MARK MATTHEW BLOMBERG DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070777

License Status

CANCELLED

Business

Title

First Name

MARK

Middle

MATTHEW

Last Name

BLOMBERG

Business Name

MARK MATTHEW BLOMBERG DO

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/12/2018