SAMUEL JAMES BALLENTINE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036149844

License Status

ACTIVE

Business

Title

First Name

SAMUEL

Middle

JAMES

Last Name

BALLENTINE

Business Name

SAMUEL JAMES BALLENTINE MD

Original Issue Date

06/19/2019

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63109

Ever Disciplined

LastModifiedDate

04/06/2023