JORGE BLACKALLER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

CANCELLED

Business

First Name

JORGE

Last Name

BLACKALLER

Suffix

Business Name

JORGE BLACKALLER MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1990

City

BERWYN

State

Zip

60402

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/11/2017