EMMETT LEE WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036052892

License Status

NOT RENEWED

Business

First Name

EMMETT LEE

Last Name

WALLACE

Suffix

Business Name

EMMETT LEE WALLACE MD

Original Issue Date

06/10/1976

Effective Date

03/20/2019

Expiration Date

09/30/2020

City

DAVENPORT

State

Zip

52809

County

IOWA

Ever Disciplined

LastModifiedDate

01/14/2021