DAVID F WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

First Name

DAVID F

Last Name

WALLACE

Suffix

Business Name

DAVID F WALLACE MD

Original Issue Date

06/12/1996

Effective Date

06/12/2017

Expiration Date

09/30/2020

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021