License holder summary

BRENT E. WALLACE is a Board Of Medicine licensed to practice in Idaho. The address on file for BRENT E. WALLACE is 3955 Harrison Boulevard Ogden UT 84403. This licensed professional license is not current. The license was granted 07/17/1978 and expired on 07/01/1977.

Idaho

Division of Occupational and Professional Licenses

BRENT E. WALLACE
Board Of Medicine
License number
M-3811
Date granted
07/17/1978
Date expires
07/01/1977
Class
Board Of Medicine
Status
Canceled
Address
3955 Harrison Boulevard Ogden UT 84403
idaholicensing.com
ID 48342981
LAST UPDATED 2024-03-15 12:37:28 UTC

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