JOHN ALLEN VAN WAGONER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

Title

First Name

JOHN

Middle

ALLEN

Last Name

VAN WAGONER

Business Name

JOHN ALLEN VAN WAGONER MD

Original Issue Date

08/20/2018

Effective Date

08/20/2018

Expiration Date

09/30/2020

City

PLANO

State

Zip

75093

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021