TIMOTHY R WALLACE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125018944

License Status

EXPIRED

Business

First Name

TIMOTHY

Middle

Last Name

WALLACE

Business Name

TIMOTHY R WALLACE

Original Issue Date

07/30/1985

Effective Date

07/30/1985

Expiration Date

07/01/1988

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Pediatric Surgery

Ever Disciplined

LastModifiedDate

09/22/2006