JACOB LEVI WAGNER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

ACTIVE

Business

Title

First Name

JACOB

Middle

LEVI

Last Name

WAGNER

Business Name

JACOB LEVI WAGNER MD

Original Issue Date

09/24/2014

Effective Date

04/12/2023

Expiration Date

07/31/2026

City

GALENA

State

Zip

61036

County

JO DAVIESS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2023