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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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WOLF, MITCHELL ANDREW       
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: SSM HEALTH MEDICAL GROUP SHAWNEE
3315 KETHLEY RD.
SHAWNEE OK 74804

Address last updated on 6/2/2024
Phone #: (405) 273-5801
Fax #: (405) 273-5172
County: POTTAWATOMIE
License: 18589
Dated: 7/2/1993
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Nv Sch Of Med, Reno Nv 89557
Graduated: 5 / 1990
CME Year: 2027
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 FAMILY MEDICINE
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: SSM Health St. Anthony Shawnee Hospital (fmly Unity Health Ctr)
Shawnee, OK
Locations: Hours: Languages:
SSM HEALTH MEDICAL GROUP SHAWNEE
3315 KETHLEY RD.
SHAWNEE OK 74804

Phone #: (405) 273-5801
Fax #: (405) 273-5172
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Spanish
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
FILIMON AGUILAR APRN 86997
ADAM DUANE HOGUE PA 1680
JAMIE JONES APRN 105408
CARY DOUGLAS NATION PA 1393
KARYN TAYLOR APRN 71175

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