JACK ALAN WAGONER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036100314

License Status

ACTIVE

Business

First Name

JACK

Middle

ALAN

Last Name

WAGONER

Suffix

Business Name

JACK ALAN WAGONER MD

Original Issue Date

06/14/1999

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

SYCAMORE

State

Zip

60178

County

DEKALB

Ever Disciplined

LastModifiedDate

04/15/2023