ERNEST MATTHEW WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

ACTIVE

Business

First Name

ERNEST

Middle

MATTHEW

Last Name

WALLACE

Suffix

Business Name

ERNEST MATTHEW WALLACE MD

Original Issue Date

02/08/2005

Effective Date

04/19/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/19/2023