PHILIP A WALLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

PHILIP A

Last Name

WALLER

Suffix

Business Name

PHILIP A WALLER MD

Original Issue Date

05/24/1991

Effective Date

05/24/1991

Expiration Date

07/31/1993

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006