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BLAKE, KENNETH DARCY       
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: 4200 WEST MEMORIAL ROAD
SUITE 909
OKLAHOMA CITY OK 73120
Phone #: (405) 749-4201
Fax #: (405) 749-4208
County: OKLAHOMA
License: 19278
Dated: 3/25/1995
Expires: 3/1/2004
License Type: Medical Doctor
Specialty: General Surgery
Colon & Rectal Surgery
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Johns Hopkins Univ Sch Of Med, Baltimore Md 21205
Graduated: 5 / 1983
CME Year: 2004
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 COLON AND RECTAL SURGERY
AMERICAN BOARD OF SURGERY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
4200 WEST MEMORIAL ROAD
SUITE 909
OKLAHOMA CITY OK 73120

Phone #: (405) 749-4201
Fax #: (405) 749-4208

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