BRIAN SCOTT WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036120375

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

SCOTT

Last Name

WALLACE

Suffix

Business Name

BRIAN SCOTT WALLACE MD

Original Issue Date

04/02/2008

Effective Date

06/03/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017