BRIAN SCOTT WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049404

License Status

EXPIRED

Business

First Name

BRIAN

Middle

SCOTT

Last Name

WALLACE

Suffix

Business Name

BRIAN SCOTT WALLACE MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

07/31/2008