DONALD R WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

First Name

DONALD R

Last Name

WALLACE

Suffix

Business Name

DONALD R WALLACE MD

Original Issue Date

11/02/1988

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

HANNA CITY

State

Zip

61636

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023