BRYAN WAYNE RANDOLPH DPM Podiatrist License verification

Business Entity

INACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016004928

License Status

INACTIVE

Business

First Name

BRYAN

Middle

WAYNE

Last Name

RANDOLPH

Suffix

DPM

Business Name

BRYAN WAYNE RANDOLPH DPM

Original Issue Date

07/29/1999

Effective Date

07/29/1999

Expiration Date

01/31/2001

City

NATCHITOCHES

State

Zip

71457

County

LOUISIANA

Ever Disciplined

LastModifiedDate

10/09/2006