BLAKE WILLIAM MILLER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

ACTIVE

Business

Title

First Name

BLAKE

Middle

WILLIAM

Last Name

MILLER

Business Name

BLAKE WILLIAM MILLER DO

Original Issue Date

10/24/2024

Effective Date

10/24/2024

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/24/2024