MARK STEVEN WALLACE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036089547

License Status

INACTIVE

Business

First Name

MARK STEVEN

Last Name

WALLACE

Suffix

Business Name

MARK STEVEN WALLACE MD

Original Issue Date

08/26/1994

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

SAINT LOUIS

State

Zip

63141

Ever Disciplined

LastModifiedDate

04/17/2008