JONATHAN W WALLACE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125037877

License Status

EXPIRED

Business

First Name

JONATHAN

Middle

Last Name

WALLACE

Business Name

JONATHAN W WALLACE

Original Issue Date

06/16/1998

Effective Date

06/16/1998

Expiration Date

06/15/2003

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006