ROY MARSHALL WAGNER DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076579

License Status

CANCELLED

Business

Title

First Name

ROY

Middle

MARSHALL

Last Name

WAGNER

Business Name

ROY MARSHALL WAGNER DO

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

06/30/2023

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/15/2020