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Oklahoma Board of Medical Licensure and Supervision

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Next Update: Thursday, December 19, 2024 12:00 PM CST

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BLACK, BRADFORD TODD       
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: ST JOSEPH REGIONAL MEDICAL CENTER
415 FAIRVIEW
PONCA CITY OK 74601

Address last updated on 3/2/2000
Phone #:
Fax #: (580) 763-0030
County: KAY
License: 21429
Dated: 1/5/2000
Expires: 1/1/2002
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Tufts Univ Sch Of Med, Boston Ma 02111
Graduated: 6 / 1994
CME Year: 2003
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:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
ST JOSEPH REGIONAL MEDICAL CENTER
415 FAIRVIEW
PONCA CITY OK 74601

Phone #:
Fax #: (580) 763-0030

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