WALTER JOSEPH FAILLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

Title

First Name

WALTER

Middle

JOSEPH

Last Name

FAILLACE

Business Name

WALTER JOSEPH FAILLACE MD

Original Issue Date

02/11/2009

Effective Date

04/05/2011

Expiration Date

07/31/2014

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017