BENJAMIN JOSEPH WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

ACTIVE

Business

Title

First Name

BENJAMIN

Middle

JOSEPH

Last Name

WAGNER

Business Name

BENJAMIN JOSEPH WAGNER DO

Original Issue Date

05/26/2016

Effective Date

06/09/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/09/2023