ELIZABETH A RANDOLPH Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

NOT RENEWED

Business

First Name

ELIZABETH

Middle

Last Name

RANDOLPH

Business Name

ELIZABETH A RANDOLPH

Original Issue Date

10/16/2013

Effective Date

03/03/2014

Expiration Date

03/01/2016

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

04/25/2016