CHAD ERIC WAGONER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040586

License Status

EXPIRED

Business

First Name

CHAD

Middle

ERIC

Last Name

WAGONER

Business Name

CHAD ERIC WAGONER

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006