ANDREW APPLEQUIST WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043602

License Status

EXPIRED

Business

First Name

ANDREW

Middle

APPLEQUIST

Last Name

WALLACE

Suffix

Business Name

ANDREW APPLEQUIST WALLACE MD

Original Issue Date

07/01/2001

Effective Date

07/01/2001

Expiration Date

06/30/2004

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006