RANDAL LEE WRAALSTAD DPM Podiatrist License verification

Business Entity

INACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016004804

License Status

INACTIVE

Business

First Name

RANDAL LEE

Last Name

WRAALSTAD

Suffix

DPM

Business Name

RANDAL LEE WRAALSTAD DPM

Original Issue Date

12/02/1996

Effective Date

02/01/2007

Expiration Date

01/31/2009

City

TWIN FALLS

State

Zip

83301

County

IDAHO

Ever Disciplined

LastModifiedDate

11/14/2008