DR. MATTHEW ROGER BLACK
Idaho SPHY-0477 Canceled
This Idaho license was held by DR. MATTHEW ROGER BLACK. The license is no longer active. It was granted on 08/27/2008 and expired on 12/31/2008
LICENSE DETAILS
- License Number: SPHY-0477
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 08/27/2008 (over 15 years ago)
- Expiry Date: 12/31/2008 (over 15 years ago)
LOCATIONS
A Residential
450 E Main Rexburg ID 83440