DETWEILER, EDWIN LYLE - Licensee Information

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

DETWEILER, EDWIN LYLE

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	SW OKLAHOMA STATE UNIVERSITY 100 CAMPUS DRIVE WEATHERFORD OK 73096 Address last updated on 8/30/2024
Phone #:	(580) 774-3073
Fax #:
County:	BLAINE
License:	624
Dated:	9/16/2010
Expires:	8/31/2025
Temp. Ltr. Issued:	8/25/2010
Temp. Ltr. Expires:	9/17/2010
License Type:	Athletic Trainer
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	0

Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
SW OKLAHOMA STATE UNIVERSITY 100 CAMPUS DRIVE WEATHERFORD OK 73096 Phone #: (580) 774-3073 Fax #:

Name:	Type:	License Number:
Primary Supervisor(s):
BLAKE ALLEN BADGETT	MD	22800
MICHAEL EDWIN KIEHN	MD	23364

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