BENJAMIN JARED WALLACE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062220

License Status

CANCELLED

Business

Title

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

City

WESLEY CHAPEL

State

Zip

33545

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/10/2012