LISLE WILLIAM BLACKBOURN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080395

License Status

ACTIVE

Business

Title

First Name

LISLE

Middle

WILLIAM

Last Name

BLACKBOURN

Business Name

LISLE WILLIAM BLACKBOURN MD

Original Issue Date

07/01/2025

Effective Date

07/01/2025

Expiration Date

06/30/2026

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

02/26/2025