FEBE IRIS WALLACE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

CANCELLED

Business

First Name

FEBE

Middle

IRIS

Last Name

WALLACE

Suffix

Business Name

FEBE IRIS WALLACE MD

Original Issue Date

11/04/1999

Effective Date

11/04/1999

Expiration Date

07/31/2005

City

LOVES PARK

State

Zip

61111

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006