BRUCE ALLEN WALLACE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036171615

License Status

ACTIVE

Business

Title

First Name

BRUCE

Middle

ALLEN

Last Name

WALLACE

Business Name

BRUCE ALLEN WALLACE DO

Original Issue Date

08/19/2024

Effective Date

08/19/2024

Expiration Date

07/31/2026

City

NORTHVILLE

State

Zip

48167

Ever Disciplined

LastModifiedDate

08/19/2024