BENJAMIN ANTHONY NICOTERA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073108

License Status

EXPIRED

Business

Title

First Name

BENJAMIN

Middle

ANTHONY

Last Name

NICOTERA

Business Name

BENJAMIN ANTHONY NICOTERA MD

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2021

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/11/2022