BENJAMIN BRADLEY WILDE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055012

License Status

CANCELLED

Business

Title

First Name

BENJAMIN

Middle

BRADLEY

Last Name

WILDE

Business Name

BENJAMIN BRADLEY WILDE DO

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/11/2008