ALAN L WAGONER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

ALAN L

Last Name

WAGONER

Suffix

Business Name

ALAN L WAGONER MD

Original Issue Date

08/19/1985

Effective Date

08/19/1985

Expiration Date

07/31/1990

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006