BENJAMIN DANIEL LONG MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

DANIEL

Last Name

LONG

Business Name

BENJAMIN DANIEL LONG MD

Original Issue Date

01/18/2024

Effective Date

01/18/2024

Expiration Date

07/31/2026

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2024