CHRISTINA R WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

First Name

CHRISTINA

Middle

Last Name

WAGNER

Suffix

Business Name

CHRISTINA R WAGNER MD

Original Issue Date

09/26/2005

Effective Date

08/20/2015

Expiration Date

07/31/2017

City

WALNUT HILL

State

Zip

62893

County

MARION

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017