JON ANTHONY WAGNON DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

ACTIVE

Business

Title

First Name

JON

Middle

ANTHONY

Last Name

WAGNON

Business Name

JON ANTHONY WAGNON DO

Original Issue Date

04/23/2008

Effective Date

07/24/2023

Expiration Date

07/31/2026

City

GODFREY

State

Zip

62035

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/24/2023