CLETUS G WAGNER MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036047423

License Status

INACTIVE

Business

First Name

CLETUS G

Last Name

WAGNER

Suffix

Business Name

CLETUS G WAGNER MD

Original Issue Date

06/05/1973

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

04/07/2011