DONALD C BLAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****82

License Status

NOT RENEWED

Business

First Name

DONALD C

Last Name

BLAKE

Suffix

Business Name

DONALD C BLAKE MD

Original Issue Date

09/18/1990

Effective Date

09/18/1990

Expiration Date

07/31/1996

City

BELVIDERE

State

Zip

61008

County

BOONE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020