SUMER KAY ALLENSWORTH WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****65

License Status

ACTIVE

Business

Title

First Name

SUMER

Middle

KAY ALLENSWORTH

Last Name

WALLACE

Business Name

SUMER KAY ALLENSWORTH WALLACE MD

Original Issue Date

08/17/2017

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61114

County

MINNESOTA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023