Jon Kevin Blake

Controlled Substance Registration - Physician

Indiana  01034169B   Active

This Indiana license is held by Jon Kevin Blake. The license is currently active. It was granted on 03/01/1985 and expired on 10/31/2015

LICENSE DETAILS

  • License Number: 01034169B
  • Category: CSR-Physician
  • Status: Active
  • Date Granted: 03/01/1985 (about 40 years ago)
  • Expiry Date: 10/31/2015 (over 9 years ago)

LOCATIONS

A Address

P.O. Box 40 925 E. Main Street, Gas City IN 46933