License holder summary

Theodore Thomas Wagner, III is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Theodore Thomas Wagner, III is 213 Fairview Blvd, Kendallville IN 46755. This licensed professional license is current. The license was granted 04/16/1999 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Theodore Thomas Wagner, III
Controlled Substance Registration - Physician
License number
01050471B
Date granted
04/16/1999
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
213 Fairview Blvd, Kendallville IN 46755
indianalicensing.org
ID 5875097
LAST UPDATED 2024-02-25 05:07:54 UTC

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