KENNETH W BENTLEY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

NOT RENEWED

Business

First Name

KENNETH

Middle

Last Name

BENTLEY

Suffix

Business Name

KENNETH W BENTLEY MD

Original Issue Date

09/12/2011

Effective Date

04/17/2017

Expiration Date

09/30/2020

City

CENTRALIA

State

Zip

62801

County

MARION

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021