COREY A BLACK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****14

License Status

NOT RENEWED

Business

First Name

COREY

Middle

Last Name

BLACK

Business Name

COREY A BLACK

Original Issue Date

01/18/2001

Effective Date

06/11/2020

Expiration Date

07/31/2023

City

MOUNT VERNON

State

Zip

62864

County

MCHENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023