STEPHEN EARL WALLACE 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

STEPHEN EARL

Last Name

WALLACE

Suffix

Business Name

STEPHEN EARL WALLACE MD

Original Issue Date

01/01/1997

Effective Date

06/29/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021