JEFFREY L BLACK 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

JEFFREY L

Last Name

BLACK

Suffix

Business Name

JEFFREY L BLACK MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

CHAMPAIGN

State

Zip

61810

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006