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Oklahoma Board of Medical Licensure and Supervision

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MACINNIS, COLLEEN RENEE       
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: 1503 BUENOS AIRES BLVD BLDG 100
THE VILLAGES FL 32162-0000

Address last updated on 6/15/2008
Phone #: (352) 343-2461
Fax #: (352) 343-5968
County: NOT OKLAHOMA
License: 21249
Dated: 7/7/1999
Expires: 7/1/2009
Training Issued: 7/1/1998
Training Expires: 8/1/1999
License Type: Medical Doctor
Specialty: Dermatology
Cytopathology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1998
CME Year: 2011
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 DERMATOLOGY
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna PPO
BlueChoice PPO
HealthChoice
Preferred Community Choice
Welcor/Sooner
Hospital Privileges: None listed
Locations: Hours: Languages:
1503 BUENOS AIRES BLVD BLDG 100
THE VILLAGES FL 32162-0000

Phone #: (352) 343-2461
Fax #: (352) 343-5968
Mon: 8:00AM - 5:00PM OUT
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat: CLOSED
Sun: CLOSED

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