JOHN RANDALL FREDRICK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

JOHN RANDALL

Last Name

FREDRICK

Suffix

Business Name

JOHN RANDALL FREDRICK MD

Original Issue Date

02/26/1996

Effective Date

02/26/1996

Expiration Date

07/31/1996

City

MOUNT CARMEL

State

Zip

62863

County

EDWARDS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006