JONATHAN EDWARD BLAKE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

ACTIVE

Business

First Name

JONATHAN

Middle

EDWARD

Last Name

BLAKE

Suffix

Business Name

JONATHAN EDWARD BLAKE DO

Original Issue Date

10/10/2013

Effective Date

08/03/2023

Expiration Date

07/31/2026

City

JERSEYVILLE

State

Zip

62052

County

JERSEY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/03/2023