BENJAMIN JON MORENO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049144

License Status

CANCELLED

Business

First Name

BENJAMIN

Middle

JON

Last Name

MORENO

Suffix

Business Name

BENJAMIN JON MORENO MD

Original Issue Date

06/01/2005

Effective Date

06/01/2005

Expiration Date

06/30/2008

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

06/10/2011