DONALD C BLAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

First Name

DONALD C

Last Name

BLAKE

Suffix

Business Name

DONALD C BLAKE MD

Original Issue Date

05/25/1993

Effective Date

05/25/1993

Expiration Date

07/31/1996

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020