Indiana
Professional Licensing Agency
Jacob Eric David Moore
Controlled Substance Registration - Physician
License number
01073310B
Date granted
11/04/2013
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
St. Mary Medical Center, 1500 S Lake Park Avenue, Hobart IN 46342
indianalicensing.org
ID 11952981
LAST UPDATED 2024-03-23 08:54:04 UTC
LAST UPDATED 2024-03-23 08:54:04 UTC
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