NEILLY ANN BUCKALEW MD - Medical Doctor License in Idaho | # 036151037

NEILLY ANN BUCKALEW MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151037

License Status

NOT RENEWED

Business

N

Title

MD

First Name

NEILLY

Middle

ANN

Last Name

BUCKALEW

Business Name

NEILLY ANN BUCKALEW MD

Original Issue Date

10/18/2019

Effective Date

10/18/2019

Expiration Date

09/30/2020

State

ID

Ever Disciplined

N

LastModifiedDate

01/14/2021