JEFFREY N BLOOM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

NOT RENEWED

Business

First Name

JEFFREY N

Last Name

BLOOM

Suffix

Business Name

JEFFREY N BLOOM MD

Original Issue Date

01/06/1993

Effective Date

01/06/1993

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60605

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2008