ZACHARY SCOTT WALLACE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000903

License Status

EXPIRED

Business

First Name

ZACHARY

Middle

SCOTT

Last Name

WALLACE

Suffix

Business Name

ZACHARY SCOTT WALLACE MD

Original Issue Date

05/30/2012

Effective Date

05/30/2012

Expiration Date

06/29/2012

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

08/29/2012