Idaho
Division of Occupational and Professional Licenses
RANDALL A BLACK
Board Of Medicine
License number
O-0445
Date granted
05/01/2007
Date expires
06/30/2018
Class
Board Of Medicine
Status
Renewed
Address
1512 12th Ave. Rd. NAMPA ID 83686
idaholicensing.com
ID 48329246
LAST UPDATED 2024-02-01 20:01:08 UTC
LAST UPDATED 2024-02-01 20:01:08 UTC
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