WALLACE M ANDERSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

ACTIVE

Business

First Name

WALLACE M

Last Name

ANDERSON

Suffix

Business Name

WALLACE M ANDERSON MD

Original Issue Date

05/03/1991

Effective Date

06/23/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/23/2023