DAVID EUGENE BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

First Name

DAVID EUGENE

Last Name

BLACKWELL

Suffix

Business Name

DAVID EUGENE BLACKWELL MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006