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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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COPPEDGE, MITCHELL DEAN       
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: FIVE OAKS FAMILY MEDICAL CLINIC
2100 W IOWA AVE
STE A
CHICKASHA OK 73018-2736

Address last updated on 6/6/2022
Phone #: (405) 779-2721
Fax #: (405) 779-2310
County: GRADY
License: 19462
Dated: 8/24/1995
Expires: 8/1/2025
Training Issued: 6/30/1994
Training Expires: 6/1/1996
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Tx Tech Univ Hlth Sci Ctr Sch Of Med, Lubbock Tx 79430
Graduated: 5 / 1994
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: Grady Memorial Hospital
Chickasha, OK
Locations: Hours: Languages:
FIVE OAKS FAMILY MEDICAL CLINIC
2100 W IOWA AVE
STE A
CHICKASHA OK 73018-2736

Phone #: (405) 779-2721
Fax #: (405) 779-2310
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
DELANIE BERRY APRN 99427
LAURA LOUISE KADECHUK PA 1947
KYLIE LEE APRN 5585
DIADRA P. LORSEH PA 2040
DEVON JESSICA MUNCY PA 1493
MARY AMANDA ROSS PA 1949

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