BENJAMIN BRADLEY WILDE DO Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036126287

License Status

INACTIVE

Business

Title

First Name

BENJAMIN

Middle

BRADLEY

Last Name

WILDE

Business Name

BENJAMIN BRADLEY WILDE DO

Original Issue Date

07/20/2010

Effective Date

07/20/2010

Expiration Date

07/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

04/07/2011