BLAKE GRAY Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125085065

License Status

ACTIVE

Business

First Name

BLAKE

Last Name

GRAY

Business Name

BLAKE GRAY

Original Issue Date

11/04/2024

Effective Date

11/04/2024

Expiration Date

11/03/2027

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

11/04/2024