License holder summary

BENNIE CARROL BLAKE is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for BENNIE CARROL BLAKE is 1101 EAST GLENDALE BOULEVARD, VALPARAISO IN 46383. This licensed professional license is not current. The license was granted 12/31/1985 and expired on 06/30/2005.

Indiana

Professional Licensing Agency

BENNIE CARROL BLAKE
Controlled Substance Registration - Physician
License number
01027504B
Date granted
12/31/1985
Date expires
06/30/2005
Class
Controlled Substance Registration - Physician
Status
Expired
Address
1101 EAST GLENDALE BOULEVARD, VALPARAISO IN 46383
indianalicensing.org
ID 5928120
LAST UPDATED 2024-03-14 04:18:34 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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