BENJAMIN JON MORENO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036121142

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

JON

Last Name

MORENO

Suffix

Business Name

BENJAMIN JON MORENO MD

Original Issue Date

06/11/2008

Effective Date

08/01/2011

Expiration Date

07/31/2014

City

ELKHART

State

Zip

46516

County

INDIANA

Ever Disciplined

LastModifiedDate

11/17/2014