ALAN L WAGONER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125016609

License Status

EXPIRED

Business

First Name

ALAN L

Last Name

WAGONER

Suffix

Business Name

ALAN L WAGONER MD

Original Issue Date

06/01/1984

Effective Date

06/01/1984

Expiration Date

07/01/1986

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006