MITCHEL ALAN WAGNER DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

Title

First Name

MITCHEL

Middle

ALAN

Last Name

WAGNER

Business Name

MITCHEL ALAN WAGNER DO

Original Issue Date

08/18/2023

Effective Date

08/18/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/18/2023