RANDOLPH MACON RICHARDSON IV DMD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077703

License Status

INACTIVE

Business

First Name

RANDOLPH MACON

Last Name

RICHARDSON IV

Suffix

DMD

Business Name

RANDOLPH MACON RICHARDSON IV DMD

Original Issue Date

08/20/1988

Effective Date

08/20/1988

Expiration Date

07/31/1996

City

CHICAGO

State

Zip

60626

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006