JARED PAUL WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130052

License Status

NOT RENEWED

Business

Title

First Name

JARED

Middle

PAUL

Last Name

WAGNER

Business Name

JARED PAUL WAGNER MD

Original Issue Date

04/12/2012

Effective Date

04/12/2012

Expiration Date

07/31/2014

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014