Indiana
Professional Licensing Agency
DAVID JACKSON DIETZ
Controlled Substance Registration - Physician
License number
01019749B
Date granted
10/31/1984
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
2810 ETHEL AVENUE, MUNCIE IN 47304
indianalicensing.org
ID 5897952
LAST UPDATED 2024-04-05 00:59:09 UTC
LAST UPDATED 2024-04-05 00:59:09 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.