MAXWELL DAVID WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036162180

License Status

ACTIVE

Business

Title

First Name

MAXWELL

Middle

DAVID

Last Name

WALLACE

Business Name

MAXWELL DAVID WALLACE MD

Original Issue Date

08/26/2022

Effective Date

05/14/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63108

Ever Disciplined

LastModifiedDate

05/14/2023