Indiana
Professional Licensing Agency
John Shively
Controlled Substance Registration - Physician
License number
01032390B
Date granted
07/31/1997
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
3701 S.R. 26 East, Lafayette IN 47905
indianalicensing.org
ID 5879955
LAST UPDATED 2024-04-07 00:58:54 UTC
LAST UPDATED 2024-04-07 00:58:54 UTC
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