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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

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BLACKSHAW, DAVID GLENN       
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: 4300 N LINCOLN BLVD
OKLAHOMA CITY OK 73105

Address last updated on 6/10/2024
Phone #: (405) 425-0383
Fax #:
County: OKLAHOMA
License: 16528
Dated: 7/1/1988
Expires: 7/1/2025
Training Issued: 8/31/1987
Training Expires: 9/30/1988
License Type: Medical Doctor
Specialty: Addiction Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 7 / 1987
CME Year: 2027
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
7/20/2017 Probation Ended
11/6/2014 Modification Order
5/17/2012 Probation
3/16/2012 Complaint Citation
2/17/2012 Suspension, License
Board Filings and/or Orders:
08/09/2017
11/10/2014
05/17/2012
03/16/2012
03/16/2012
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
4300 N LINCOLN BLVD
OKLAHOMA CITY OK 73105

Phone #: (405) 425-0383
Fax #:
Mon: 8:00AM - 4:30PM
Tue: 8:00AM - 4:30PM
Wed: 8:00AM - 4:30PM
Thu: 8:00AM - 4:30PM
Fri: 8:00AM - 12:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
LIZBER BRYAN APRN 2081
AMY GONZALEZ APRN 131471
DEBRA MCCULLOCK APRN 47643
MICHAEL SCAMMAHORN APRN 81026

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