SANDRA B BENCKENDORF Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

SANDRA

Middle

Last Name

BENCKENDORF

Business Name

SANDRA B BENCKENDORF

Original Issue Date

01/01/1997

Effective Date

07/01/2011

Expiration Date

07/31/2014

City

MORTON

State

Zip

61550

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2014