FREDERICK WILLIAM WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036124604

License Status

ACTIVE

Business

First Name

FREDERICK

Middle

WILLIAM

Last Name

WAGNER

Suffix

Business Name

FREDERICK WILLIAM WAGNER MD

Original Issue Date

11/10/2009

Effective Date

06/05/2023

Expiration Date

07/31/2026

City

MARYVILLE

State

Zip

62062

County

MADISON

Ever Disciplined

LastModifiedDate

04/16/2024