JACK ALAN WAGONER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

ACTIVE

Business

First Name

JACK

Middle

ALAN

Last Name

WAGONER

Suffix

Business Name

JACK ALAN WAGONER MD

Original Issue Date

06/15/1999

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

SYCAMORE

State

Zip

60178

County

DEKALB

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023