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KOPPULA, MOREEN M. C. S.       
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: 4130 EAST VAN BUREN #250
PHOENIX AZ 85008
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 13903
Dated: 7/27/1982
Expires: 6/30/1987
License Type: Medical Doctor
Specialty: Anesthesiology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: INDIA MEDICAL SCHOOLS
Graduated: / 1973
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:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
4130 EAST VAN BUREN #250
PHOENIX AZ 85008

Phone #:
Fax #:

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