MARK L PETERSEN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036066326

License Status

INACTIVE

Business

First Name

MARK L

Last Name

PETERSEN

Suffix

Business Name

MARK L PETERSEN MD

Original Issue Date

03/25/1983

Effective Date

03/25/1983

Expiration Date

07/31/1987

City

IDAHO FALLS

State

Zip

83401

County

IDAHO

Ever Disciplined

LastModifiedDate

09/20/2006