FARREL K VAN WAGENEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093646

License Status

NOT RENEWED

Business

First Name

FARREL K

Last Name

VAN WAGENEN

Suffix

Business Name

FARREL K VAN WAGENEN MD

Original Issue Date

07/18/1996

Effective Date

07/18/1996

Expiration Date

07/31/1999

City

BRENTWOOD

State

Zip

63144

County

MISSOURI

Ever Disciplined

LastModifiedDate

09/20/2006