License holder summary

Jeffrey Lynn Wallace is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Jeffrey Lynn Wallace is 309 SHANDELL DRIVE, Bedford IN 47421. This licensed professional license is not current. The license was granted 07/01/1994 and expired on 06/30/2005.

Indiana

Professional Licensing Agency

Jeffrey Lynn Wallace
Controlled Substance Registration - Physician
License number
01042832B
Date granted
07/01/1994
Date expires
06/30/2005
Class
Controlled Substance Registration - Physician
Status
Expired
Address
309 SHANDELL DRIVE, Bedford IN 47421
indianalicensing.org
ID 5822201
LAST UPDATED 2024-03-12 09:29:26 UTC

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