BERYL LYNN RANDOLPH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

BERYL

Middle

LYNN

Last Name

RANDOLPH

Suffix

Business Name

BERYL LYNN RANDOLPH MD

Original Issue Date

03/06/2001

Effective Date

03/06/2001

Expiration Date

07/31/2002

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006