BERYL LYNN RANDOLPH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036104142

License Status

NOT RENEWED

Business

First Name

BERYL

Middle

LYNN

Last Name

RANDOLPH

Suffix

Business Name

BERYL LYNN RANDOLPH MD

Original Issue Date

02/05/2001

Effective Date

02/05/2001

Expiration Date

07/31/2002

City

FORT WAYNE

State

Zip

46825

County

INDIANA

Ever Disciplined

LastModifiedDate

10/09/2006