JACK C BLACKSTONE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

JACK

Middle

Last Name

BLACKSTONE

Suffix

Business Name

JACK C BLACKSTONE MD

Original Issue Date

07/18/2014

Effective Date

07/18/2014

Expiration Date

07/31/2017

City

BLOOMINGTON

State

Zip

47401

County

INDIANA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017