Indiana
Professional Licensing Agency
John L. Bormann
Controlled Substance Registration - Physician
License number
01042016B
Date granted
12/02/1993
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
6119 West Jefferson Blvd, Fort Wayne IN 46804
indianalicensing.org
ID 5853708
LAST UPDATED 2024-02-05 21:50:30 UTC
LAST UPDATED 2024-02-05 21:50:30 UTC
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