CLETUS G WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

NOT RENEWED

Business

First Name

CLETUS G

Last Name

WAGNER

Suffix

Business Name

CLETUS G WAGNER MD

Original Issue Date

01/01/1997

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011