MARY C BLAZEK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

NOT RENEWED

Business

First Name

MARY C

Last Name

BLAZEK

Suffix

Business Name

MARY C BLAZEK MD

Original Issue Date

09/26/1990

Effective Date

09/26/1990

Expiration Date

07/31/1999

City

ROCKFORD

State

Zip

61107

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006