BENJAMIN DANIEL LONG MD - Medical Doctor License in Illinois | # 125071892

BENJAMIN DANIEL LONG MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071892

License Status

CANCELLED

Business

N

Title

MD

First Name

BENJAMIN

Middle

DANIEL

Last Name

LONG

Business Name

BENJAMIN DANIEL LONG MD

Original Issue Date

06/26/2021

Effective Date

06/26/2021

Expiration Date

06/25/2023

State

IL

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

N

LastModifiedDate

03/10/2021