DAVID B WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

DAVID B

Last Name

WALLACE

Suffix

Business Name

DAVID B WALLACE MD

Original Issue Date

01/01/1997

Effective Date

07/17/2017

Expiration Date

09/30/2020

City

AURORA

State

Zip

60506

County

KANE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021