BRIAN SCOTT WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

SCOTT

Last Name

WALLACE

Suffix

Business Name

BRIAN SCOTT WALLACE MD

Original Issue Date

04/07/2008

Effective Date

06/03/2014

Expiration Date

07/31/2017

City

ARLINGTON HEIGHTS

State

Zip

60005

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017