TIMOTHY ROBERT WALL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

TIMOTHY ROBERT

Last Name

WALL

Suffix

Business Name

TIMOTHY ROBERT WALL MD

Original Issue Date

09/25/1981

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

NAPERVILLE

State

Zip

60563

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021