RAYMOND B WALLACE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125031972

License Status

EXPIRED

Business

First Name

RAYMOND B

Last Name

WALLACE

Suffix

Business Name

RAYMOND B WALLACE DO

Original Issue Date

06/24/1994

Effective Date

06/24/1994

Expiration Date

06/26/1997

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006