LISA A BENNING Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020680

License Status

EXPIRED

Business

First Name

LISA A

Last Name

BENNING

Business Name

LISA A BENNING

Original Issue Date

05/04/1987

Effective Date

05/04/1987

Expiration Date

06/26/1990

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006