License holder summary

PATRICE JACKSON PRATOOMRATANA is a Board Of Medicine licensed to practice in Idaho. The address on file for PATRICE JACKSON PRATOOMRATANA is 4700 South 5th Ave #1 Pocatello ID 83204. This licensed professional license is not current. The license was granted 08/02/2006 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

PATRICE JACKSON PRATOOMRATANA
Board Of Medicine
License number
LRT-1182
Date granted
08/02/2006
Date expires
06/30/2017
Class
Board Of Medicine
Status
Reinstated
Address
4700 South 5th Ave #1 Pocatello ID 83204
idaholicensing.com
ID 48359580
LAST UPDATED 2024-02-23 14:49:49 UTC

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