DOUGLAS ALAN BLAZER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****59

License Status

ACTIVE

Business

First Name

DOUGLAS

Middle

ALAN

Last Name

BLAZER

Business Name

DOUGLAS ALAN BLAZER

Original Issue Date

11/10/2011

Effective Date

01/26/2026

Expiration Date

03/01/2028

City

ROCKFORD

State

Zip

61109

County

WINNEBAGO

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/26/2026