MARY DIZER WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

MARY DIZER

Last Name

WAGNER

Suffix

Business Name

MARY DIZER WAGNER MD

Original Issue Date

06/22/1993

Effective Date

06/22/1993

Expiration Date

07/31/1996

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006