PETER J WALLER DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067269

License Status

EXPIRED

Business

First Name

PETER

Middle

Last Name

WALLER

Suffix

Business Name

PETER J WALLER DO

Original Issue Date

06/25/2015

Effective Date

06/25/2015

Expiration Date

06/24/2018

City

SKOKIE

State

Zip

60076

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/25/2018