BENJAMIN G M BAUTISTA II MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130758

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

G M

Last Name

BAUTISTA

Suffix

Business Name

BENJAMIN G M BAUTISTA II MD

Original Issue Date

07/06/2012

Effective Date

07/15/2023

Expiration Date

07/31/2026

City

APPLETON

State

Zip

54915

County

WISCONSIN

Ever Disciplined

LastModifiedDate

07/15/2023