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Oklahoma Board of Medical Licensure and Supervision

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

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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.
Practice Address: 350 S 40TH ST
MUSKOGEE OK 74401-4915

Address last updated on 3/18/2019
Phone #: (918) 683-0753
Fax #: (918) 687-5251
County: MUSKOGEE
License: 12244
Dated: 5/25/1979
Expires: 12/21/2020
License Type: Medical Doctor
Specialty: Cardiovascular Disease
Internal Medicine
Status: Inactive
Status Class: Deceased
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Santo Tomas, Fac Of Med And Surg, Manila, Philippines
Graduated: 4 / 1972
CME Year: 2022
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 INTERNAL MEDICINE
AMERICAN BOARD OF INTERNAL MEDICINE - Cardiovascular Disease
New Patients: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
350 S 40TH ST
MUSKOGEE OK 74401-4915

Phone #: (918) 683-0753
Fax #: (918) 687-5251
Spanish
Chinese (Mandarin)
Arabic

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