RANDALL WAYNE JENNINGS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

RANDALL

Middle

WAYNE

Last Name

JENNINGS

Suffix

Business Name

RANDALL WAYNE JENNINGS MD

Original Issue Date

06/25/2002

Effective Date

06/25/2002

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020