License holder summary

JACQUELINE Y GERVAIS is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for JACQUELINE Y GERVAIS is 3229 BROADWAY, GARY IN 46409. This licensed professional license is not current. The license was granted 12/30/1986 and expired on 06/30/1997.

Indiana

Professional Licensing Agency

JACQUELINE Y GERVAIS
Controlled Substance Registration - Physician
License number
01031357B
Date granted
12/30/1986
Date expires
06/30/1997
Class
Controlled Substance Registration - Physician
Status
Expired
Address
3229 BROADWAY, GARY IN 46409
indianalicensing.org
ID 5856719
LAST UPDATED 2024-03-05 07:22:14 UTC

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