THOMAS MERLE WALLER DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070583

License Status

CANCELLED

Business

Title

First Name

THOMAS

Middle

MERLE

Last Name

WALLER

Business Name

THOMAS MERLE WALLER DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/23/2017