License holder summary

DR. MATTHEW ROGER BLACK is a Board Of Medicine licensed to practice in Idaho. The address on file for DR. MATTHEW ROGER BLACK is 450 E Main Rexburg ID 83440. This licensed professional license is not current. The license was granted 04/23/2008.

Idaho

Division of Occupational and Professional Licenses

DR. MATTHEW ROGER BLACK
Board Of Medicine
License number
O-0477
Date granted
04/23/2008
Class
Board Of Medicine
Status
Revoked
Address
450 E Main Rexburg ID 83440
idaholicensing.com
ID 48329243
LAST UPDATED 2024-03-23 19:59:15 UTC

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