WALLACE WAYNE GIST MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036029575

License Status

NOT RENEWED

Business

First Name

WALLACE WAYNE

Last Name

GIST

Suffix

Business Name

WALLACE WAYNE GIST MD

Original Issue Date

09/15/1949

Effective Date

09/15/1949

Expiration Date

07/01/1982

City

PUEBLO

State

Zip

81001

County

COLORADO

Ever Disciplined

LastModifiedDate

09/20/2006