MARY MELANIE WALLER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

ACTIVE

Business

First Name

MARY

Middle

MELANIE

Last Name

WALLER

Suffix

Business Name

MARY MELANIE WALLER MD

Original Issue Date

08/30/2007

Effective Date

04/10/2023

Expiration Date

07/31/2026

City

OLNEY

State

Zip

62450

County

RICHLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/10/2023