FREDRICK HUBERT WALLISCH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

CANCELLED

Business

First Name

FREDRICK

Middle

HUBERT

Last Name

WALLISCH

Suffix

Business Name

FREDRICK HUBERT WALLISCH MD

Original Issue Date

03/03/1998

Effective Date

03/03/1998

Expiration Date

07/31/2005

City

OFALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006