DARREL J WAGGONER Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

ACTIVE

Business

First Name

DARREL J

Last Name

WAGGONER

Business Name

DARREL J WAGGONER

Original Issue Date

12/20/1999

Effective Date

04/07/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2023