License holder summary

JACK DALE TOLLIVER is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for JACK DALE TOLLIVER is NORTH CLARK COMMUNITY HOSPITAL, C/O EMERGENCY ROOM, CHARLESTOWN IN 47111. This licensed professional license is not current. The license was granted 10/07/1980 and expired on 12/31/1982.

Indiana

Professional Licensing Agency

JACK DALE TOLLIVER
Controlled Substance Registration - Physician
License number
01030474B
Date granted
10/07/1980
Date expires
12/31/1982
Class
Controlled Substance Registration - Physician
Status
Expired
Address
NORTH CLARK COMMUNITY HOSPITAL, C/O EMERGENCY ROOM, CHARLESTOWN IN 47111
indianalicensing.org
ID 5833057
LAST UPDATED 2024-04-17 10:03:03 UTC

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