DALE WESLEY BLAISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

DALE WESLEY

Last Name

BLAISE

Suffix

Business Name

DALE WESLEY BLAISE MD

Original Issue Date

04/29/1993

Effective Date

04/29/1993

Expiration Date

07/31/1993

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020