ROBERT PERRY RANDOLPH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****38

License Status

CANCELLED

Business

First Name

ROBERT PERRY

Last Name

RANDOLPH

Suffix

Business Name

ROBERT PERRY RANDOLPH MD

Original Issue Date

03/12/1984

Effective Date

03/12/1984

Expiration Date

07/31/2005

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006