J RANDOLPH LEWIS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****56

License Status

NOT RENEWED

Business

First Name

J RANDOLPH

Last Name

LEWIS

Suffix

Business Name

J RANDOLPH LEWIS MD

Original Issue Date

11/04/1996

Effective Date

06/11/2008

Expiration Date

07/31/2011

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011