STEPHANIE JAYNE WAGNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055080

License Status

EXPIRED

Business

Title

First Name

STEPHANIE

Middle

JAYNE

Last Name

WAGNER

Business Name

STEPHANIE JAYNE WAGNER MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

07/19/2011