ALAN SCOTT WAGNER MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036099687

License Status

INACTIVE

Business

First Name

ALAN

Middle

SCOTT

Last Name

WAGNER

Suffix

Business Name

ALAN SCOTT WAGNER MD

Original Issue Date

02/22/1999

Effective Date

09/01/2020

Expiration Date

07/31/2023

City

ROCKFORD

State

Zip

61114

Ever Disciplined

LastModifiedDate

06/13/2023