Idaho
Division of Occupational and Professional Licenses
JACK F HAGEN
Board Of Medicine
License number
PGT-002
Date granted
12/22/2003
Date expires
06/30/2005
Class
Board Of Medicine
Status
Upgraded
Address
3040 S THOMAS MLL PL NAMPA ID 83686
idaholicensing.com
ID 48334336
LAST UPDATED 2026-03-23 12:28:57 UTC
LAST UPDATED 2026-03-23 12:28:57 UTC
This website is unaffiliated with the Division of Occupational and Professional Licenses. Please verify all information directly with the relevant official government authority.