THOMAS MERLE WALLER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****02

License Status

ACTIVE

Business

Title

First Name

THOMAS

Middle

MERLE

Last Name

WALLER

Business Name

THOMAS MERLE WALLER DO

Original Issue Date

01/31/2022

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

NILES

State

Zip

60714

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023