BENJAMIN S BALTASAR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048642

License Status

NOT RENEWED

Business

First Name

BENJAMIN S

Last Name

BALTASAR

Suffix

Business Name

BENJAMIN S BALTASAR MD

Original Issue Date

02/05/1974

Effective Date

05/23/2014

Expiration Date

07/31/2017

City

LAKE IN THE HILLS

State

Zip

60156

County

MCHENRY

Ever Disciplined

LastModifiedDate

11/01/2017