LARRY WILLIAM BLUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

LARRY WILLIAM

Last Name

BLUM

Suffix

Business Name

LARRY WILLIAM BLUM MD

Original Issue Date

01/01/1997

Effective Date

04/15/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020