ETHAN PACE WALKER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075298

License Status

EXPIRED

Business

First Name

ETHAN

Middle

PACE

Last Name

WALKER

Business Name

ETHAN PACE WALKER

Original Issue Date

08/07/2019

Effective Date

08/07/2019

Expiration Date

08/06/2022

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/11/2022