LAUREN ASHLEY WALLACE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065769

License Status

CANCELLED

Business

Title

First Name

LAUREN

Middle

ASHLEY

Last Name

WALLACE

Business Name

LAUREN ASHLEY WALLACE MD

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

BERGER

State

Zip

63014

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/12/2014