BRUCE ALLEN WALLACE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

ACTIVE

Business

Title

First Name

BRUCE

Middle

ALLEN

Last Name

WALLACE

Business Name

BRUCE ALLEN WALLACE DO

Original Issue Date

09/17/2024

Effective Date

09/17/2024

Expiration Date

07/31/2026

City

LAWRENCEVILLE

State

Zip

62439

County

LAWRENCE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/17/2024