Frederic Leslie Jackson
Controlled Substance Registration-Osteopathic Physician
Indiana 02001678B Expired
This Indiana license was held by Frederic Leslie Jackson. The license is no longer active. It was granted on 09/29/1995 and expired on 06/30/2005
LICENSE DETAILS
- License Number: 02001678B
- Category: CSR-Osteopathic Physician
- Status: Expired
- Date Granted: 09/29/1995 (over 30 years ago)
- Expiry Date: 06/30/2005 (almost 21 years ago)
LOCATIONS
A Address
FORT WAYNE MEDICAL EDUCATION PROGRAM, 2434 LAKE AVENUE, FORT WAYNE IN 46805