BLAKE ROSS MILLER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083284

License Status

ACTIVE

Business

Title

First Name

BLAKE

Middle

ROSS

Last Name

MILLER

Business Name

BLAKE ROSS MILLER MD

Original Issue Date

06/26/2024

Effective Date

06/26/2024

Expiration Date

06/25/2027

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

04/12/2024