License holder summary

Deborah S.I. Provisor is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Deborah S.I. Provisor is P O BOX 40407, 1707 WEST 86TH STREET, INDIANAPOLIS IN 46240. This licensed professional license is not current. The license was granted 03/31/1986 and expired on 06/30/1997.

Indiana

Professional Licensing Agency

Deborah S.I. Provisor
Controlled Substance Registration - Physician
License number
01024413B
Date granted
03/31/1986
Date expires
06/30/1997
Class
Controlled Substance Registration - Physician
Status
Expired
Address
P O BOX 40407, 1707 WEST 86TH STREET, INDIANAPOLIS IN 46240
indianalicensing.org
ID 5869117
LAST UPDATED 2024-02-07 13:04:01 UTC

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