REBECCA A WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036061374

License Status

NOT RENEWED

Business

First Name

REBECCA A

Last Name

WAGNER

Suffix

Business Name

REBECCA A WAGNER MD

Original Issue Date

12/03/1980

Effective Date

06/11/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

11/01/2017