License holder summary

RUSSELL SCOTT PETERSEN is a Board Of Medicine licensed to practice in Idaho. The address on file for RUSSELL SCOTT PETERSEN is 5121 S. Cottonwood St. SALT LAKE CITY UT 84157. This licensed professional license is not current. The license was granted 08/31/1992 and expired on 08/01/2011.

Idaho

Division of Occupational and Professional Licenses

RUSSELL SCOTT PETERSEN
Board Of Medicine
License number
M-6058
Date granted
08/31/1992
Date expires
08/01/2011
Class
Board Of Medicine
Status
Canceled
Address
5121 S. Cottonwood St. SALT LAKE CITY UT 84157
idaholicensing.com
ID 48348793
LAST UPDATED 2024-03-15 03:52:47 UTC

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