Matthew Jay Fackrell
Medical Residency Permit
Indiana 11012380A Superceded
This Indiana license was held by Matthew Jay Fackrell. The license is no longer active. It was granted on 06/16/2004 and expired on 06/30/2005
LICENSE DETAILS
- License Number: 11012380A
- Category: Medical Residency Permit
- Status: Superceded
- Date Granted: 06/16/2004 (almost 21 years ago)
- Expiry Date: 06/30/2005 (almost 20 years ago)
LOCATIONS
A Address
Fort Wayne IN 46804