Indiana
Professional Licensing Agency
THOMAS JAY FOUNTAINE
Controlled Substance Registration - Physician
License number
01015602B
Date granted
10/31/1985
Date expires
06/30/1989
Class
Controlled Substance Registration - Physician
Status
Expired
Address
1620 18TH STREET, BEDFORD IN 47421
indianalicensing.org
ID 5822671
LAST UPDATED 2024-05-02 11:53:18 UTC
LAST UPDATED 2024-05-02 11:53:18 UTC
This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.