License holder summary

Dr. BLAKE D NIEDERHAUSER is a Board Of Medicine licensed to practice in Idaho. The address on file for Dr. BLAKE D NIEDERHAUSER is 115 W MAIN ST BOISE ID 83702. This licensed professional license is current. The license was granted 03/14/2014 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

Dr. BLAKE D NIEDERHAUSER
Board Of Medicine
License number
M-12384
Date granted
03/14/2014
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
115 W MAIN ST BOISE ID 83702
idaholicensing.com
ID 48338772
LAST UPDATED 2024-02-02 23:52:22 UTC

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