DAVID F WALLACE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036092919

License Status

INACTIVE

Business

First Name

DAVID F

Last Name

WALLACE

Suffix

Business Name

DAVID F WALLACE MD

Original Issue Date

05/28/1996

Effective Date

06/12/2017

Expiration Date

09/30/2020

City

OFALLON

State

Zip

62269

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

04/05/2020