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Oklahoma Board of Medical Licensure and Supervision

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MATLOCK, MARK STEPHEN       
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: 2829 S JACKSON AVENUE
JOPLIN MO 64804

Address last updated on 6/4/2001
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 14296
Dated: 7/1/1983
Expires: 7/1/2002
License Type: Medical Doctor
Specialty: Dermatology
Status: Inactive
Status Class: Deceased
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 1982
CME Year: 2003
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 DERMATOLOGY
New Patients: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
2829 S JACKSON AVENUE
JOPLIN MO 64804

Phone #:
Fax #:

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