JAMES E WALLACE JR Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****22

License Status

NOT RENEWED

Business

First Name

JAMES E

Last Name

WALLACE JR

Business Name

JAMES E WALLACE JR

Original Issue Date

05/22/2001

Effective Date

02/10/2016

Expiration Date

03/01/2018

State

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

05/02/2018