Idaho
Division of Occupational and Professional Licenses
MICHAEL DOUGLAS RUSSELL
Board Of Medicine
License number
M-7024
Date granted
06/14/1996
Date expires
07/01/1991
Class
Board Of Medicine
Status
Canceled
Address
338 Cedar Ln Longview WA 98632
idaholicensing.com
ID 48363739
LAST UPDATED 2024-03-04 18:15:35 UTC
LAST UPDATED 2024-03-04 18:15:35 UTC
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