TOM R BURCHAM JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

NOT RENEWED

Business

First Name

TOM R

Last Name

BURCHAM JR

Suffix

Business Name

TOM R BURCHAM JR MD

Original Issue Date

01/01/1997

Expiration Date

09/01/1982

City

MENARD

State

Zip

62259

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006