MARY DIZER WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036086310

License Status

NOT RENEWED

Business

First Name

MARY DIZER

Last Name

WAGNER

Suffix

Business Name

MARY DIZER WAGNER MD

Original Issue Date

06/01/1993

Effective Date

06/01/1993

Expiration Date

07/31/1996

City

CHAMPAIGN

State

Zip

61821

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/20/2006