RANDAL JACK PETERSON MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019240

License Status

EXPIRED

Business

Title

First Name

RANDAL

Middle

JACK

Last Name

PETERSON

Business Name

RANDAL JACK PETERSON MD

Original Issue Date

05/22/1986

Effective Date

05/22/1986

Expiration Date

06/26/1989

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006