LANCE T WALLACE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125025495

License Status

EXPIRED

Business

First Name

LANCE T

Last Name

WALLACE

Business Name

LANCE T WALLACE

Original Issue Date

06/18/1990

Effective Date

06/18/1990

Expiration Date

06/19/1993

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006