Matthew Jay Fackrell
Controlled Substance Registration-Osteopathic Physician
Indiana 02002954B Expired
This Indiana license was held by Matthew Jay Fackrell. The license is no longer active. It was granted on 06/23/2005 and expired on 06/30/2007
LICENSE DETAILS
- License Number: 02002954B
- Category: CSR-Osteopathic Physician
- Status: Expired
- Date Granted: 06/23/2005 (almost 20 years ago)
- Expiry Date: 06/30/2007 (almost 18 years ago)
LOCATIONS
A Address
Fort Wayne Medical Education Program, 2434 Lake Avenue, Fort Wayne IN 46805