GAYLE BRANSON BLAKE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****31

License Status

NOT RENEWED

Business

First Name

GAYLE

Middle

BRANSON

Last Name

BLAKE

Business Name

GAYLE BRANSON BLAKE

Original Issue Date

01/13/2005

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

03/15/2017