JOHN WALLACE SMITH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

CANCELLED

Business

First Name

JOHN

Middle

WALLACE

Last Name

SMITH

Suffix

Business Name

JOHN WALLACE SMITH MD

Original Issue Date

04/29/2002

Effective Date

11/19/2014

Expiration Date

07/31/2017

City

WILMETTE

State

Zip

60091

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014