BENJAMIN JARED WALLACE DO - Medical Doctor License in Florida | # 125062220

BENJAMIN JARED WALLACE DO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062220

License Status

CANCELLED

Business

N

Title

DO

First Name

BENJAMIN

Middle

JARED

Last Name

WALLACE

Business Name

BENJAMIN JARED WALLACE DO

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

State

FL

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

N

LastModifiedDate

05/10/2012