Indiana
Professional Licensing Agency
Jon Kevin Blake
Controlled Substance Registration - Physician
License number
01034169B
Date granted
03/01/1985
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
P.O. Box 40 925 E. Main Street, Gas City IN 46933
indianalicensing.org
ID 5857958
LAST UPDATED 2026-05-06 21:46:49 UTC
LAST UPDATED 2026-05-06 21:46:49 UTC
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