BENJAMIN MILES STAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

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

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014