RICHARD ETHAN BIVIN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

ACTIVE

Business

First Name

RICHARD

Middle

ETHAN

Last Name

BIVIN

Suffix

Business Name

RICHARD ETHAN BIVIN MD

Original Issue Date

03/29/2001

Effective Date

05/12/2023

Expiration Date

07/31/2026

City

LINCOLN

State

Zip

62656

County

LOGAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/12/2023