MARK MATTHEW BLOMBERG DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

Title

First Name

MARK

Middle

MATTHEW

Last Name

BLOMBERG

Business Name

MARK MATTHEW BLOMBERG DO

Original Issue Date

05/20/2020

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2023