BENJAMIN THOMAS HEATWOLE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058287

License Status

CANCELLED

Business

Title

First Name

BENJAMIN

Middle

THOMAS

Last Name

HEATWOLE

Business Name

BENJAMIN THOMAS HEATWOLE MD

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2013

City

WINCHESTER

State

Zip

01890

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/01/2010