RANDOLPH WILLIAM ROLLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036054648

License Status

NOT RENEWED

Business

First Name

RANDOLPH

Middle

WILLIAM

Last Name

ROLLER

Suffix

Business Name

RANDOLPH WILLIAM ROLLER MD

Original Issue Date

06/09/1977

Effective Date

06/25/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/01/2017

Case Number

1994000068

Action

Probation

Discipline Start Date

10/25/1995

Discipline End Date

10/24/2000

Discipline Reason

Failing to report his dismissal from the staff of Memorial Medical Center for excessive use of alcohol.