RANDALL SCOTT BEALLIS DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036097916

License Status

NOT RENEWED

Business

First Name

RANDALL

Middle

SCOTT

Last Name

BEALLIS

Suffix

Business Name

RANDALL SCOTT BEALLIS DO

Original Issue Date

06/05/1998

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

11/06/2008