Indiana
Professional Licensing Agency
ISAAC DOR
Controlled Substance Registration - Physician
License number
01044603B
Date granted
09/15/1997
Date expires
06/30/2001
Class
Controlled Substance Registration - Physician
Status
Expired
Address
LAPORTE PROFESSIONAL BUILDING, 1300 STATE ST SUITE 2G, LAPORTE IN 46350
indianalicensing.org
ID 5878005
LAST UPDATED 2024-04-18 01:05:53 UTC
LAST UPDATED 2024-04-18 01:05:53 UTC
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