JARED PAUL WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

NOT RENEWED

Business

Title

First Name

JARED

Middle

PAUL

Last Name

WAGNER

Business Name

JARED PAUL WAGNER MD

Original Issue Date

04/12/2012

Effective Date

04/12/2012

Expiration Date

07/31/2014

City

ARLINGTON HEIGHTS

State

Zip

60004

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014