ERNEST MATTHEW WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036113040

License Status

ACTIVE

Business

First Name

ERNEST

Middle

MATTHEW

Last Name

WALLACE

Suffix

Business Name

ERNEST MATTHEW WALLACE MD

Original Issue Date

02/04/2005

Effective Date

04/19/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

04/19/2023