BLAINE L FARLESS Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

NOT RENEWED

Business

First Name

BLAINE L

Last Name

FARLESS

Business Name

BLAINE L FARLESS

Original Issue Date

02/05/1990

Effective Date

02/05/1990

Expiration Date

07/31/1993

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/26/2006