PETER J WALLER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

ACTIVE

Business

First Name

PETER

Middle

Last Name

WALLER

Suffix

Business Name

PETER J WALLER DO

Original Issue Date

07/24/2019

Effective Date

06/30/2023

Expiration Date

07/31/2026

City

SKOKIE

State

Zip

60076

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/30/2023