GRAHAM WILSON WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044578

License Status

EXPIRED

Business

First Name

GRAHAM

Middle

WILSON

Last Name

WALLACE

Suffix

Business Name

GRAHAM WILSON WALLACE MD

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

06/30/2005

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006