KORY DANE BLANK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

ACTIVE

Business

Title

First Name

KORY

Middle

DANE

Last Name

BLANK

Business Name

KORY DANE BLANK MD

Original Issue Date

05/25/2021

Effective Date

07/26/2023

Expiration Date

07/31/2026

City

FAIRFIELD

State

Zip

62837

County

WAYNE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/26/2023