License holder summary

SHANE CHRISTIAN MANGRUM is a Board Of Medicine licensed to practice in Idaho. The address on file for SHANE CHRISTIAN MANGRUM is 1150 Hammond Drive, Bldg E Atlanta GA 30328. This licensed professional license is current. The license was granted 12/03/2004 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

SHANE CHRISTIAN MANGRUM
Board Of Medicine
License number
M-9189
Date granted
12/03/2004
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
1150 Hammond Drive, Bldg E Atlanta GA 30328
idaholicensing.com
ID 48351814
LAST UPDATED 2024-03-17 21:55:42 UTC

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