Alysa M. Fog
Controlled Substance Registration-Physician Assistant
Indiana 10000973B Expired
This Indiana license was held by Alysa M. Fog. The license is no longer active. It was granted on 02/27/2009 and expired on 06/30/2012
LICENSE DETAILS
- License Number: 10000973B
- Category: CSR-Physician Assistant
- Status: Expired
- Date Granted: 02/27/2009 (over 17 years ago)
- Expiry Date: 06/30/2012 (almost 14 years ago)
LOCATIONS
A Address
Orthopaedics Northeast, P.C., 5050 N. Clinton Street, Fort Wayne IN 46825