INGRID J BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

INGRID J

Last Name

BLACKWELL

Suffix

Business Name

INGRID J BLACKWELL MD

Original Issue Date

05/27/1982

Effective Date

05/27/1982

Expiration Date

07/31/1984

City

PEORIA

State

Zip

61604

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006