JARED JOHN WALLEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

Title

First Name

JARED

Middle

JOHN

Last Name

WALLEN

Business Name

JARED JOHN WALLEN MD

Original Issue Date

12/16/2020

Effective Date

12/16/2020

Expiration Date

07/31/2023

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023