License holder summary

MARK STEPHEN RUSSUM is a Board Of Medicine licensed to practice in Idaho. The address on file for MARK STEPHEN RUSSUM is PO Box 668 Kooskia ID 83539. This licensed professional license is not current. The license was granted 09/04/1992 and expired on 07/02/2002.

Idaho

Division of Occupational and Professional Licenses

MARK STEPHEN RUSSUM
Board Of Medicine
License number
LRT-360
Date granted
09/04/1992
Date expires
07/02/2002
Class
Board Of Medicine
Status
Canceled
Address
PO Box 668 Kooskia ID 83539
idaholicensing.com
ID 48363759
LAST UPDATED 2024-03-09 05:52:15 UTC

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