DIEDRE ANN WAGERS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

Title

First Name

DIEDRE

Middle

ANN

Last Name

WAGERS

Business Name

DIEDRE ANN WAGERS MD

Original Issue Date

07/05/2012

Effective Date

07/05/2012

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014