BENJAMIN LOUIS WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125084413

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

LOUIS

Last Name

WAGNER

Business Name

BENJAMIN LOUIS WAGNER DO

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2027

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

05/22/2024