MAXWELL DAVID WALLACE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

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

05/22/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63108

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/22/2023