JAMES E WALLACE JR Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000087

License Status

INACTIVE

Business

First Name

JAMES E

Last Name

WALLACE JR

Business Name

JAMES E WALLACE JR

Original Issue Date

11/05/1980

Effective Date

02/10/2016

Expiration Date

03/01/2018

City

URBANA

State

Zip

61802

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

05/02/2018