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Next Update: Saturday, December 21, 2024 12:00 PM CST
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LESLIE, PORTER BASS
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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.
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| Practice Address: |
412 S WELLS
VICI OK 73859
Address last updated on 3/30/2010 |
| Phone #: |
(580) 995-3200 |
| Fax #: |
(580) 995-3202 |
| County: |
DEWEY |
| License: |
10616 |
| Dated: |
8/11/1975 |
| Expires: |
6/29/2011 |
| License Type: |
Medical Doctor |
| Specialty: |
General Practice
Emergency Medicine |
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| Status: |
Inactive |
| Status Class: |
Deceased |
| Restricted to: |
Agreement not to practice |
| Registered to Dispense: |
NO |
| Medical School: |
Univ Auto De Guadalajara, Fac De Med, Guadalajara, Jalisco, Mexico |
| Graduated: |
12 /
1972 |
| CME Year: |
2012 |
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Pending and/or Past Disciplinary Actions:
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| Date |
Action |
Reasons |
Remarks |
| #1/1/1900# |
Past Disciplinary Action |
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| #1/1/1900# |
Past Disciplinary Action |
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| #1/1/1900# |
Past Disciplinary Action |
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| #1/1/1900# |
Past Disciplinary Action |
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| #1/1/1900# |
Past Disciplinary Action |
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Board Filings and/or Orders:
05/09/2002
11/21/1992
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
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| New Patients: |
No |
| Medicaid: |
No |
| Medicare: |
No |
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| HMO/PPO: |
HealthChoice
United Healthcare Options PPO |
| Hospital Privileges: |
None listed |
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