BENJAMIN ROBERT STACY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

VISITING RESIDENT

License Number

188000659

License Status

NOT RENEWED

Business

Title

First Name

BENJAMIN

Middle

ROBERT

Last Name

STACY

Business Name

BENJAMIN ROBERT STACY MD

Original Issue Date

05/30/2016

Effective Date

05/30/2016

Expiration Date

11/29/2016

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

Psychiatry/Family Practice

Ever Disciplined

LastModifiedDate

03/09/2017