Idaho
Division of Occupational and Professional Licenses
TIMOTHY BRYAN HEACKOCK
Board Of Medicine
License number
PGT-011
Date granted
01/15/2004
Date expires
06/30/2006
Class
Board Of Medicine
Status
Canceled
Address
3985 WINDY AVE NE ALBANY OR 97322
idaholicensing.com
ID 48329338
LAST UPDATED 2024-05-08 15:32:57 UTC
LAST UPDATED 2024-05-08 15:32:57 UTC
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