ANDREW BENJAMIN MOORE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064548

License Status

CANCELLED

Business

Title

First Name

ANDREW

Middle

BENJAMIN

Last Name

MOORE

Business Name

ANDREW BENJAMIN MOORE MD

Original Issue Date

06/23/2017

Effective Date

06/23/2017

Expiration Date

06/22/2018

City

PORTLAND

State

Zip

97214

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

02/09/2017