PHILIP I WAGNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036042682

License Status

NOT RENEWED

Business

First Name

PHILIP I

Last Name

WAGNER

Suffix

Business Name

PHILIP I WAGNER MD

Original Issue Date

07/11/1969

Effective Date

07/11/1969

Expiration Date

07/01/1982

City

ROSEBURG

State

Zip

97470

County

OREGON

Ever Disciplined

LastModifiedDate

09/20/2006