BENJAMIN DANIEL LONG MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071892

License Status

CANCELLED

Business

Title

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

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

03/10/2021