License holder summary

DAVID SAMUEL ROTH is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for DAVID SAMUEL ROTH is CHARTER HOSP OF LAFAYETTE, 3700 ROME DR P O BOX 5969, LAFAYETTE IN 47903. This licensed professional license is not current. The license was granted 07/25/1991 and expired on 06/30/1993.

Indiana

Professional Licensing Agency

DAVID SAMUEL ROTH
Controlled Substance Registration - Physician
License number
01039574B
Date granted
07/25/1991
Date expires
06/30/1993
Class
Controlled Substance Registration - Physician
Status
Expired
Address
CHARTER HOSP OF LAFAYETTE, 3700 ROME DR P O BOX 5969, LAFAYETTE IN 47903
indianalicensing.org
ID 5879155
LAST UPDATED 2024-03-09 09:38:28 UTC

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