BENJAMIN G M BAUTISTA II MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

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

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/15/2023