License holder summary

MACK KELLEY MATA III is a Board Of Medicine licensed to practice in Idaho. The address on file for MACK KELLEY MATA III is 9150 WEST EDNA STREET BOISE ID 83704. This licensed professional license is current. The license was granted 09/08/2014 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

MACK KELLEY MATA III
Board Of Medicine
License number
LRT-1837
Date granted
09/08/2014
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
9150 WEST EDNA STREET BOISE ID 83704
idaholicensing.com
ID 48338298
LAST UPDATED 2024-02-04 17:18:36 UTC

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