MARK W WAGGENER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026699

License Status

EXPIRED

Business

First Name

MARK

Middle

Last Name

WAGGENER

Business Name

MARK W WAGGENER

Original Issue Date

05/15/1991

Effective Date

05/15/1991

Expiration Date

06/23/1994

City

CHICAGO

State

Zip

60612

County

COOK

Ever Disciplined

LastModifiedDate

09/27/2011