BENJAMIN NICHOLAS FORD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075006

License Status

EXPIRED

Business

Title

First Name

BENJAMIN

Middle

NICHOLAS

Last Name

FORD

Business Name

BENJAMIN NICHOLAS FORD MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/11/2022