Indiana
Professional Licensing Agency
Ethan Edward Wagner
Controlled Substance Registration-Osteopathic Physician
License number
02002898B
Date granted
04/07/2005
Date expires
10/31/2015
Class
Controlled Substance Registration-Osteopathic Physician
Status
Active
Address
12472 Cirrus Drive, Fishers IN 46037
indianalicensing.org
ID 5800080
LAST UPDATED 2024-03-23 13:42:57 UTC
LAST UPDATED 2024-03-23 13:42:57 UTC
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