JAN D WALLACE (Credential# 541231) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
JAN D WALLACE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.014769. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is 1501 Turpin Lake Rd, Poolville, TX 76487-3245. The current status is active.
| Licensee Name | JAN D WALLACE |
| Credential ID | 541231 |
| Credential Number | 1.014769 |
| Credential Type | Physician/Surgeon |
| Business Address |
1501 Turpin Lake Rd Poolville TX 76487-3245 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1970-12-11 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-03-02 |
| Street Address | 1501 TURPIN LAKE RD |
| City | POOLVILLE |
| State | TX |
| Zip Code | 76487-3245 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Willhite Seed | 199 Sparks St, Poolville, TX 76487-1934 | Seed Labeler | 2016-04-01 ~ 2017-03-31 |
| City | POOLVILLE |
| Zip Code | 76487 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + POOLVILLE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Keri A Wallace Md | Ct Pediatrics At Chc, Hartford, CT 06106 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Christopher A Wallace | 6 Charlotte Ct, Avon, CT 06001-2257 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Ellen C Wallace | 25 Stearns Rd, Watertown, MA 02172 | Physician/surgeon | 1994-11-02 ~ 1995-12-31 |
| Max L Wallace Jr | 383 Rockwood Drive, Southington, CT 06489 | Physician/surgeon | 2017-09-01 ~ 2018-08-31 |
| Edward P Wallace Md | 285 Broad St, Meriden, CT 06450 | Physician/surgeon | 1999-02-11 ~ 2000-02-29 |
| Michael Lloyd Wallace | 875 Greentree Rd, Pittsburgh, PA 15220-3508 | Physician/surgeon | ~ |
| Kathleen A Wallace | 8 Springbrook Lane, Simsbury, CT 06070 | Physician/surgeon | 2018-06-01 ~ 2019-05-31 |
| Sampath Gunda | 2181 Wallace Ave Apt 3e, Bronx, NY 10462-1827 | Physician/surgeon | 2013-05-23 ~ 2014-03-31 |
| Albert J Gomez | 395 Wallace Road, Nashville, TN 37211 | Physician/surgeon | 1998-04-09 ~ 1999-04-30 |
| Daniel Wallace Dahl | 40 Prospect Ave, Norwalk, CT 06850 | Physician/surgeon | 2018-01-01 ~ 2018-12-31 |
Please comment or provide details below to improve the information on JAN D WALLACE.
| 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).