JACK C BLACKSTONE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

First Name

JACK

Middle

Last Name

BLACKSTONE

Suffix

Business Name

JACK C BLACKSTONE MD

Original Issue Date

04/19/2011

Effective Date

04/19/2011

Expiration Date

07/31/2014

City

OWENSBORO

State

Zip

42303

County

KENTUCKY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017