MICHAEL LOGAN ARIEL SLACK DO - Medical Doctor License in Idaho | # 036169850

MICHAEL LOGAN ARIEL SLACK DO

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036169850

License Status

ACTIVE

Business

N

Title

DO

First Name

MICHAEL

Middle

LOGAN ARIEL

Last Name

SLACK

Business Name

MICHAEL LOGAN ARIEL SLACK DO

Original Issue Date

04/14/2024

Effective Date

04/14/2024

Expiration Date

07/31/2026

State

ID

Ever Disciplined

N

LastModifiedDate

04/14/2024