JASON BLAKE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125078351

License Status

CANCELLED

Business

Title

First Name

JASON

Last Name

BLAKE

Business Name

JASON BLAKE DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

MAYWOOD

State

Zip

60153

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

04/14/2021