Idaho
Division of Occupational and Professional Licenses
KERMIT "RUSTY" SULLIVAN
Board Of Medicine
License number
AT-182
Date granted
10/25/2000
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
1214 S SPRING VALLEY DR NAMPA ID 83686
idaholicensing.com
ID 48355459
LAST UPDATED 2024-04-09 02:12:50 UTC
LAST UPDATED 2024-04-09 02:12:50 UTC
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