ROGER ALAN CHRISTOPHER BLAKE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

ACTIVE

Business

Title

First Name

ROGER

Middle

ALAN CHRISTOPHER

Last Name

BLAKE

Business Name

ROGER ALAN CHRISTOPHER BLAKE MD

Original Issue Date

11/06/2023

Effective Date

11/06/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2023