RANDAL JACK PETERSON MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

Title

First Name

RANDAL

Middle

JACK

Last Name

PETERSON

Business Name

RANDAL JACK PETERSON MD

Original Issue Date

07/18/1990

Effective Date

05/04/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2023