JACOB WILLIAM BLASINGAME Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****14

License Status

ACTIVE

Business

First Name

JACOB

Middle

WILLIAM

Last Name

BLASINGAME

Business Name

JACOB WILLIAM BLASINGAME

Original Issue Date

02/24/2020

Effective Date

02/19/2026

Expiration Date

03/01/2028

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/19/2026