MICHAEL D. MANGUM
Idaho LRT-996 Canceled
This Idaho license was held by MICHAEL D. MANGUM. The license is no longer active. It was granted on 04/21/2003 and expired on 07/31/2010
LICENSE DETAILS
- License Number: LRT-996
- Category: Board Of Medicine
- Status: Canceled
- Date Granted: 04/21/2003 (about 22 years ago)
- Expiry Date: 07/31/2010 (over 14 years ago)
LOCATIONS
A Residential
4141 East 109 North Idaho Falls ID 83401