STEPHEN EARL WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036055346

License Status

NOT RENEWED

Business

First Name

STEPHEN EARL

Last Name

WALLACE

Suffix

Business Name

STEPHEN EARL WALLACE MD

Original Issue Date

08/11/1977

Effective Date

06/29/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/14/2021