License holder summary

MR. JEDIDIAH ALLEN PETERSEN is a Board Of Medicine licensed to practice in Idaho. The address on file for MR. JEDIDIAH ALLEN PETERSEN is 500S 11TH AVE SUITE 400 POCATELLO ID 83201. This licensed professional license is not current. The license was granted 10/18/2013 and expired on 08/01/2016.

Idaho

Division of Occupational and Professional Licenses

MR. JEDIDIAH ALLEN PETERSEN
Board Of Medicine
License number
PA-1110
Date granted
10/18/2013
Date expires
08/01/2016
Class
Board Of Medicine
Status
Canceled
Address
500S 11TH AVE SUITE 400 POCATELLO ID 83201
idaholicensing.com
ID 48348778
LAST UPDATED 2024-04-03 00:54:25 UTC

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