License holder summary

Teofilo S. Bautista is a Controlled Substance Registration - Physician licensed to practice in Indiana. The address on file for Teofilo S. Bautista is 642 South Lake Street, Gary IN 46403. This licensed professional license is current. The license was granted 12/31/1985 and expired on 10/31/2015.

Indiana

Professional Licensing Agency

Teofilo S. Bautista
Controlled Substance Registration - Physician
License number
01032450B
Date granted
12/31/1985
Date expires
10/31/2015
Class
Controlled Substance Registration - Physician
Status
Active
Address
642 South Lake Street, Gary IN 46403
indianalicensing.org
ID 5857659
LAST UPDATED 2024-03-27 06:53:09 UTC

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