DOUGLAS CHARLES WALLACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****45

License Status

NOT RENEWED

Business

First Name

DOUGLAS

Middle

CHARLES

Last Name

WALLACE

Suffix

Business Name

DOUGLAS CHARLES WALLACE MD

Original Issue Date

07/11/2008

Effective Date

04/27/2011

Expiration Date

07/31/2014

City

CAPE GIRARDEAU

State

Zip

63701

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014