DOUGLAS CHARLES WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036112410

License Status

NOT RENEWED

Business

First Name

DOUGLAS

Middle

CHARLES

Last Name

WALLACE

Suffix

Business Name

DOUGLAS CHARLES WALLACE MD

Original Issue Date

09/22/2004

Effective Date

04/20/2011

Expiration Date

07/31/2014

City

CAPE GIRARDEAU

State

Zip

63701

Ever Disciplined

LastModifiedDate

11/17/2014