ROY MARSHALL WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****13

License Status

ACTIVE

Business

Title

First Name

ROY

Middle

MARSHALL

Last Name

WAGNER

Business Name

ROY MARSHALL WAGNER DO

Original Issue Date

05/08/2023

Effective Date

05/08/2023

Expiration Date

07/31/2026

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/08/2023