EDWARD LYON RANDERSON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

Title

First Name

EDWARD

Middle

LYON

Last Name

RANDERSON

Business Name

EDWARD LYON RANDERSON MD

Original Issue Date

03/09/2021

Effective Date

03/09/2021

Expiration Date

07/31/2023

City

BEAVER DAM

State

Zip

53916

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023