DIANE LYNN JORDAN-WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

LYNN

Last Name

JORDAN-WAGNER

Suffix

Business Name

DIANE LYNN JORDAN-WAGNER MD

Original Issue Date

01/30/2003

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

PARIS

State

Zip

61944

County

EDGAR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020