MICHAEL LOGAN ARIEL SLACK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036169850

License Status

ACTIVE

Business

Title

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

City

MERIDIAN

State

Zip

83642

Ever Disciplined

LastModifiedDate

04/14/2024