RANDAL JACK PETERSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036080194

License Status

ACTIVE

Business

Title

First Name

RANDAL

Middle

JACK

Last Name

PETERSON

Business Name

RANDAL JACK PETERSON MD

Original Issue Date

06/29/1990

Effective Date

05/04/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/04/2023