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MOULTON, KRIEGH PHELPS       
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: PRAIRIE CARDIOVASCULAR CTR.
P.O. BOX 19420
SPRINGFIELD IL 62794
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 15818
Dated: 7/1/1986
Expires: 6/30/1992
License Type: Medical Doctor
Specialty: Internal Medicine
Cardiovascular Disease
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Southern Il Univ Sch Of Med, Springfield Il 62794
Graduated: 6 / 1983
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 INTERNAL MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
PRAIRIE CARDIOVASCULAR CTR.
P.O. BOX 19420
SPRINGFIELD IL 62794

Phone #:
Fax #:

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