LANCE T WALLACE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

First Name

LANCE T

Last Name

WALLACE

Business Name

LANCE T WALLACE

Original Issue Date

07/02/1993

Effective Date

07/22/2023

Expiration Date

07/31/2026

City

MATTESON

State

Zip

60443

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/22/2023