RICHARD DOUGLAS SOUTHGATE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

Title

First Name

RICHARD

Middle

DOUGLAS

Last Name

SOUTHGATE

Business Name

RICHARD DOUGLAS SOUTHGATE MD

Original Issue Date

12/15/2022

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

LAKE FOREST

State

Zip

60045

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023