MARK THOMAS TAKEO TAKAKI MD - Medical Doctor License in Idaho | # 036118842

MARK THOMAS TAKEO TAKAKI MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036118842

License Status

NOT RENEWED

Business

N

First Name

MARK THOMAS

Middle

TAKEO

Last Name

TAKAKI

Suffix

MD

Business Name

MARK THOMAS TAKEO TAKAKI MD

Original Issue Date

06/28/2007

Effective Date

07/12/2017

Expiration Date

09/30/2020

State

ID

Ever Disciplined

N

LastModifiedDate

01/14/2021