BRIAN BENJAMIN BLACKMON D.O. Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

ACTIVE

Business

Title

D.O.

First Name

BRIAN

Middle

BENJAMIN

Last Name

BLACKMON

Business Name

BRIAN BENJAMIN BLACKMON D.O.

Original Issue Date

04/07/2017

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60660

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023