CHARLES R BLACKWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036040659

License Status

NOT RENEWED

Business

First Name

CHARLES R

Last Name

BLACKWELL

Suffix

Business Name

CHARLES R BLACKWELL MD

Original Issue Date

09/01/1966

Effective Date

09/01/1966

Expiration Date

07/31/1999

City

ST LOUIS

State

Zip

63132

County

MISSOURI

Ever Disciplined

LastModifiedDate

09/20/2006