DAVID JOSEPH WALLACE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062133

License Status

CANCELLED

Business

Title

First Name

DAVID

Middle

JOSEPH

Last Name

WALLACE

Business Name

DAVID JOSEPH WALLACE MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Neurological Surgery

Ever Disciplined

LastModifiedDate

08/19/2015