RANDALL R ODEM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

RANDALL R

Last Name

ODEM

Suffix

Business Name

RANDALL R ODEM MD

Original Issue Date

12/20/2018

Effective Date

12/20/2018

Expiration Date

09/30/2020

City

SAINT LOUIS

State

Zip

63108

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021