REBECCA A WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

REBECCA A

Last Name

WAGNER

Suffix

Business Name

REBECCA A WAGNER MD

Original Issue Date

01/01/1997

Effective Date

06/11/2014

Expiration Date

07/31/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017