BENJAMIN MILES STAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036131074

License Status

NOT RENEWED

Business

Title

First Name

BENJAMIN

Middle

MILES

Last Name

STAKE

Business Name

BENJAMIN MILES STAKE MD

Original Issue Date

08/06/2012

Effective Date

08/06/2012

Expiration Date

07/31/2014

City

ALBUQUERQUE

State

Zip

87106

County

NEW MEXICO

Ever Disciplined

LastModifiedDate

11/17/2014

Case Number

2014001444

Action

Surrender In Lieu Of Other Discipline

Discipline Start Date

08/08/2014

Discipline Reason

for prior disciplinary action taken by the New Mexico medical board and failure to report the discipline to the department.