License holder summary

PROFESSIONAL EMER PHYS is a Medical Licensing Board - Medical Corporation licensed to practice in Indiana. The address on file for PROFESSIONAL EMER PHYS is 2200 RANDALIA DRIVE, FORT WAYNE IN 46805. This licensed professional license is not current. The license was granted 07/29/1971 and expired on 01/31/2004.

Indiana

Professional Licensing Agency

PROFESSIONAL EMER PHYS
Medical Licensing Board - Medical Corporation
License number
50000306A
Date granted
07/29/1971
Date expires
01/31/2004
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
2200 RANDALIA DRIVE, FORT WAYNE IN 46805
indianalicensing.org
ID 24826927
LAST UPDATED 2024-03-15 02:44:59 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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