DANIEL LEWIS WAGONER DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141250

License Status

NOT RENEWED

Business

Title

First Name

DANIEL

Middle

LEWIS

Last Name

WAGONER

Business Name

DANIEL LEWIS WAGONER DO

Original Issue Date

07/18/2016

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60614

County

COOK

Ever Disciplined

LastModifiedDate

01/14/2021