MARK F BLUMENTHAL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

CANCELLED

Business

First Name

MARK F

Last Name

BLUMENTHAL

Suffix

Business Name

MARK F BLUMENTHAL MD

Original Issue Date

08/12/1987

Effective Date

08/12/1987

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006