ALAN SCOTT WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

ALAN

Middle

SCOTT

Last Name

WAGNER

Suffix

Business Name

ALAN SCOTT WAGNER MD

Original Issue Date

03/19/1999

Effective Date

09/01/2020

Expiration Date

07/31/2023

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023