BENJAMIN GRANT LAURITZEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055456

License Status

EXPIRED

Business

Title

First Name

BENJAMIN

Middle

GRANT

Last Name

LAURITZEN

Business Name

BENJAMIN GRANT LAURITZEN MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

07/19/2011