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BLOOM, LEWIS THEIL       
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: PRATT REGIONAL MEDICAL CENTER
200 COMMODORE
PRATT KS 67124
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 12033
Dated: 10/5/1978
Expires: 10/1/1996
License Type: Medical Doctor
Specialty: Diagnostic Radiology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of KS Sch Of Med, Kansas City Ks 66103
Graduated: 6 / 1957
CME Year:
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.
Certifications: AMERICAN BOARD OF RADIOLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
PRATT REGIONAL MEDICAL CENTER
200 COMMODORE
PRATT KS 67124

Phone #:
Fax #:

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