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Oklahoma Board of Medical Licensure and Supervision

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GRANT, PENNY       
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: OKLAHOMA UNIVERSITY - TULSA
DEPARTMENT OF PEDIATRICS
2815 S SHERIDAN ROAD
TULSA OK 74129-1045
Phone #: (918) 831-4550
Fax #: (918) 838-4822
County: TULSA
License: 21402
Dated: 11/22/1999
Expires: 11/1/2005
License Type: Medical Doctor
Specialty: Pediatrics
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: NEW YORK MED COLL, VALHALLA NY 10595
Graduated: 5 / 1984
CME Year: 2005
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 PEDIATRICS
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
OKLAHOMA UNIVERSITY - TULSA
DEPARTMENT OF PEDIATRICS
2815 S SHERIDAN ROAD
TULSA OK 74129-1045

Phone #: (918) 831-4550
Fax #: (918) 838-4822

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