Indiana
Professional Licensing Agency
Thomas Mark Malott
Controlled Substance Registration-Physician Assistant
License number
10000716B
Date granted
06/05/2009
Date expires
06/30/2016
Class
Controlled Substance Registration-Physician Assistant
Status
Active
Address
Dukes Physicians Services, LLC, 285 W 12th Street Ste 112, Peru IN 46970
indianalicensing.org
ID 8388289
LAST UPDATED 2024-01-13 03:31:39 UTC
LAST UPDATED 2024-01-13 03:31:39 UTC
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