MARK W PETERSON MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036074456

License Status

INACTIVE

Business

First Name

MARK W

Last Name

PETERSON

Suffix

Business Name

MARK W PETERSON MD

Original Issue Date

01/31/1987

Effective Date

01/31/1987

Expiration Date

07/31/1987

City

LEWISTON

State

Zip

83501

Ever Disciplined

LastModifiedDate

09/20/2006