BENJAMIN E MONTGOMERY Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042278

License Status

EXPIRED

Business

First Name

BENJAMIN

Middle

Last Name

MONTGOMERY

Business Name

BENJAMIN E MONTGOMERY

Original Issue Date

06/19/2001

Effective Date

06/19/2001

Expiration Date

06/30/2004

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006