RANDALL LEWIS MULLIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

NOT RENEWED

Business

First Name

RANDALL

Middle

LEWIS

Last Name

MULLIN

Suffix

Business Name

RANDALL LEWIS MULLIN MD

Original Issue Date

01/01/1997

Effective Date

04/22/2014

Expiration Date

07/31/2017

City

GENESEO

State

Zip

61254

County

HENRY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017