Idaho
Division of Occupational and Professional Licenses
S. C. STANDARD
Board Of Medicine
License number
M-0548
Date granted
04/06/1910
Date expires
04/06/1910
Class
Board Of Medicine
Status
Canceled
Address
1302 Medical Dental Building Seattle
idaholicensing.com
ID 48371446
LAST UPDATED 2026-05-31 10:43:08 UTC
LAST UPDATED 2026-05-31 10:43:08 UTC
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