DARREL J WAGGONER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028536

License Status

EXPIRED

Business

First Name

DARREL J

Last Name

WAGGONER

Business Name

DARREL J WAGGONER

Original Issue Date

06/02/1992

Effective Date

06/02/1992

Expiration Date

06/23/1995

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006