BENJAMIN SCOTT WALLIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058338

License Status

CANCELLED

Business

Title

First Name

BENJAMIN

Middle

SCOTT

Last Name

WALLIS

Business Name

BENJAMIN SCOTT WALLIS MD

Original Issue Date

06/23/2013

Effective Date

06/23/2013

Expiration Date

06/22/2014

City

EVANSTON

State

Zip

60201

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

04/16/2013