JUSTIN DAVID BLASBERG 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

Title

First Name

JUSTIN

Middle

DAVID

Last Name

BLASBERG

Business Name

JUSTIN DAVID BLASBERG MD

Original Issue Date

06/11/2014

Effective Date

06/11/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017