BENJAMIN JOSEPH WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036140784

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

JOSEPH

Last Name

WAGNER

Business Name

BENJAMIN JOSEPH WAGNER DO

Original Issue Date

05/26/2016

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

06/09/2023