CHAD ERIC WAGONER - Medical Doctor License in Illinois | # 125040586

CHAD ERIC WAGONER

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040586

License Status

EXPIRED

Business

N

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

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006