RANDALL DAVID GRANT DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****24

License Status

ACTIVE

Business

Title

First Name

RANDALL

Middle

DAVID

Last Name

GRANT

Business Name

RANDALL DAVID GRANT DO

Original Issue Date

12/28/2016

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

RIVER FOREST

State

Zip

60305

County

NEW YORK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023