RANDOLPH MACON RICHARDSON IV DMD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

RANDOLPH MACON

Last Name

RICHARDSON IV

Suffix

DMD

Business Name

RANDOLPH MACON RICHARDSON IV DMD

Original Issue Date

03/03/1989

Effective Date

03/03/1989

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60657

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006