License holder summary

David Lee Wallace is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for David Lee Wallace is 200 High Park Avenue, Goshen IN 46526. This licensed professional license is current. The license was granted 04/30/1986 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

David Lee Wallace
Controlled Substance Registration - Physician
License number
01027186B
Date granted
04/30/1986
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
200 High Park Avenue, Goshen IN 46526
indianalicensing.org
ID 5887862
LAST UPDATED 2024-03-08 10:48:34 UTC

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