SCOTT BLAINE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130001400

License Status

EXPIRED

Business

Title

First Name

SCOTT

Last Name

BLAINE

Business Name

SCOTT BLAINE DO

Original Issue Date

06/28/2021

Effective Date

06/28/2021

Expiration Date

12/27/2021

City

CHICAGO

State

Zip

60611

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

10/11/2022