JONATHAN W WALLACE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

ACTIVE

Business

First Name

JONATHAN

Middle

Last Name

WALLACE

Business Name

JONATHAN W WALLACE

Original Issue Date

04/07/2003

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

HOFFMAN ESTATES

State

Zip

60192

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023