License holder summary

Lisa Ann Bergeron is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Lisa Ann Bergeron is Maplecrest Pediatrics, 6108 Maplecrest Road, Fort Wayne IN 46835. This licensed professional license is current. The license was granted 07/14/1995 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Lisa Ann Bergeron
Controlled Substance Registration - Physician
License number
01043876B
Date granted
07/14/1995
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
Maplecrest Pediatrics, 6108 Maplecrest Road, Fort Wayne IN 46835
indianalicensing.org
ID 5854003
LAST UPDATED 2024-03-08 16:28:18 UTC

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