RICHARD WILLARD WAGONER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

ACTIVE

Business

First Name

RICHARD

Middle

WILLARD

Last Name

WAGONER

Suffix

Business Name

RICHARD WILLARD WAGONER MD

Original Issue Date

06/04/2001

Effective Date

05/26/2023

Expiration Date

07/31/2026

City

HAVANA

State

Zip

62644

County

MASON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/26/2023