Indiana
Professional Licensing Agency
Deitrick LeEllen Gorman
Controlled Substance Registration-Osteopathic Physician
License number
02003270B
Date granted
10/23/2007
Date expires
10/31/2015
Class
Controlled Substance Registration-Osteopathic Physician
Status
Active
Address
Fort Wayne Medical Education Program, 750 Broadway Suite# 250, Fort Wayne IN 46802-1412
indianalicensing.org
ID 5800379
LAST UPDATED 2024-05-04 05:05:00 UTC
LAST UPDATED 2024-05-04 05:05:00 UTC
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