WAYNE DAVID LEROY BENTHAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036153548

License Status

NOT RENEWED

Business

Title

First Name

WAYNE

Middle

DAVID LEROY

Last Name

BENTHAM

Business Name

WAYNE DAVID LEROY BENTHAM MD

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

07/31/2023

City

GREEN BAY

State

Zip

54301

County

BROWN

Ever Disciplined

LastModifiedDate

11/30/2023