FREDERICK WILLIAM WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

ACTIVE

Business

First Name

FREDERICK

Middle

WILLIAM

Last Name

WAGNER

Suffix

Business Name

FREDERICK WILLIAM WAGNER MD

Original Issue Date

11/12/2009

Effective Date

06/05/2023

Expiration Date

07/31/2026

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2023