DOUGLAS ALAN BLAZER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004130

License Status

ACTIVE

Business

First Name

DOUGLAS

Middle

ALAN

Last Name

BLAZER

Business Name

DOUGLAS ALAN BLAZER

Original Issue Date

09/15/2011

Effective Date

01/26/2026

Expiration Date

03/01/2028

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/26/2026