DR. MATTHEW ROGER BLACK
Idaho O-0477 Revoked
This Idaho license was held by DR. MATTHEW ROGER BLACK. The license is no longer active. It was granted on 04/23/2008
LICENSE DETAILS
- License Number: O-0477
- Category: Board Of Medicine
- Status: Revoked
- Date Granted: 04/23/2008 (almost 16 years ago)
LOCATIONS
A Residential
450 E Main Rexburg ID 83440