BENJAMIN JARED WALLACE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036162223

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

JARED

Last Name

WALLACE

Business Name

BENJAMIN JARED WALLACE DO

Original Issue Date

08/30/2022

Effective Date

06/29/2023

Expiration Date

07/31/2026

City

WESLEY CHAPEL

State

Zip

33545

Ever Disciplined

LastModifiedDate

06/29/2023