FALLON H MAYLACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036083789

License Status

NOT RENEWED

Business

First Name

FALLON H

Last Name

MAYLACK

Suffix

Business Name

FALLON H MAYLACK MD

Original Issue Date

12/03/1991

Effective Date

07/06/2011

Expiration Date

07/31/2014

City

BRIDGETON

State

Zip

63044

County

MISSOURI

Ever Disciplined

LastModifiedDate

11/17/2014