License holder summary

Brian David Wallace is a Medical Residency Permit licensed to practice in Indiana. The address on file for Brian David Wallace is Bowling Green KY 42103. This licensed professional license is not current. The license was granted 06/24/2000 and expired on 06/30/2002.

Indiana

Professional Licensing Agency

Brian David Wallace
Medical Residency Permit
License number
11010128A
Date granted
06/24/2000
Date expires
06/30/2002
Class
Medical Residency Permit
Status
Superceded
Address
Bowling Green KY 42103
indianalicensing.org
ID 5969594
LAST UPDATED 2024-03-07 18:28:42 UTC

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