License holder summary

THEODORE STEVEN ROOSEVELT is a Board Of Medicine licensed to practice in Idaho. The address on file for THEODORE STEVEN ROOSEVELT is 9196 W EMERALD ST STE 160 BOISE ID 83704. This licensed professional license is current. The license was granted 12/18/1992 and expired on 06/30/2017.

Idaho

Division of Occupational and Professional Licenses

THEODORE STEVEN ROOSEVELT
Board Of Medicine
License number
M-6142
Date granted
12/18/1992
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
9196 W EMERALD ST STE 160 BOISE ID 83704
idaholicensing.com
ID 48349007
LAST UPDATED 2024-02-21 00:44:53 UTC

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