MATTHEW C WALLACE MD (Credential# 462428) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2009. The license expiration date date is February 28, 2011. The license status is INACTIVE.
MATTHEW C WALLACE MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0041093. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2009. The expiration date is February 28, 2011. The business address is 4330 Spectrum One, San Antonio, TX 78230. The current status is inactive.
| Licensee Name | MATTHEW C WALLACE MD |
| Credential ID | 462428 |
| Credential Number | CSP.0041093 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
4330 Spectrum One San Antonio TX 78230 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE |
| Issue Date | 2007-02-07 |
| Effective Date | 2009-03-01 |
| Expiration Date | 2011-02-28 |
| Refresh Date | 2013-03-07 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 561458 | 1.043876 | Physician/Surgeon | 2005-10-19 | 2008-12-04 - 2010-01-31 | INACTIVE |
| 380167 | CSP.0035903 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | - | EXPIRED APPLICATION |
| Street Address | 4330 SPECTRUM ONE |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78230 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Venkata Praveen Mallina | 12330 Vance Jackson Rd, San Antonio, TX 78230 | Registered Nurse | ~ |
| Valerie Ann Broadwater | 11845 Ih 10w, San Antonio, TX 78230 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Anthony Jesus Juarez | 13306 Heights Park, San Antonio, TX 78230 | Registered Nurse | 2018-03-01 ~ 2019-02-28 |
| Bexr Logistix LLC | 38505 Ih 10 West Ste# 1000, San Antonio, TX 78230 | Wholesaler of Drugs, Cosmetics & Medical Devices | 2018-07-01 ~ 2019-06-30 |
| Maria D Lucio | 12104 Mission Trace, San Antonio, TX 78230 | Registered Nurse | 2016-05-01 ~ 2017-04-30 |
| Mission Pharmacal Company | 10999 Ih 10 West, San Antonio, TX 78230 | Out of State Manufacturer of Drugs, Cosmetics & Medical Devices | 2017-02-28 ~ |
| Warren R Jesser | 9859 Ihiow #227, San Antonio, TX 78230 | Real Estate Broker | ~ |
| Norine B Ouellette · Norine Ballantine | 3327 Old Forge Drive, San Antonio, TX 78230 | Dental Hygienist | ~ |
| Peggy A Walter | 10710 Lost Hilltop St, San Antonio, TX 78230 | Registered Nurse | 2009-03-31 ~ 2010-05-31 |
| Holly L Cirlin | 3622 Sugarhill Drive, San Antonio, TX 78230 | Registered Nurse | 2009-03-13 ~ 2010-04-30 |
| Find all Licenses in zip 78230 | |||
| City | SAN ANTONIO |
| Zip Code | 78230 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + SAN ANTONIO |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| E F Wallace Dvm | Torrington Rd, Litchfield, CT 06759 | Controlled Substance Registration for Practitioner | 1994-04-15 ~ 1996-05-01 |
| Richard B Wallace Md | 7 Devonshire Dr, Waterford, CT 06385-1701 | Controlled Substance Registration for Practitioner | 2003-03-01 ~ 2004-02-28 |
| Suemoy Wallace | 80 Seymour St, Hartford, CT 06102-8000 | Controlled Substance Registration for Practitioner | 2009-09-14 ~ 2011-02-28 |
| Lee Wallace Md | 40 Hart Street, New Britain, CT 06052 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Lydia Wallace | 289 Green St, Boston, MA 02130-2660 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Wallace B Hirschberg | 27 Bridge Street, Stamford, CT 06905 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Leah G Wallace | 10 Pattagansett Court, Niantic, CT 06357 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Elizabeth C Wallace | 1099 Merritt St, Fairfield, CT 06825-1531 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Angela B Pressley-wallace | 15 Butler Dr, Glastonbury, CT 06033-3510 | Controlled Substance Registration for Practitioner | 2017-03-01 ~ 2019-02-28 |
| David Wallace | 39 Allen Pl, Staten Island, NY 10312-5901 | Controlled Substance Registration for Practitioner | 2019-06-28 ~ 2021-02-28 |
Please comment or provide details below to improve the information on MATTHEW C WALLACE MD.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).