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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST

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NGO, LOC KIM       
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. JOHN BROKEN ARROW
EMERGENCY DEPT
1000 W BOISE CIRCLE
BROKEN ARROW OK 74012

Address last updated on 2/13/2024
Phone #: (918) 994-8080
Fax #:
County: TULSA
License: 21508
Dated: 4/13/2000
Expires: 4/1/2025
License Type: Medical Doctor
Specialty: Emergency Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1997
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 EMERGENCY MEDICINE
New Patients: No
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: Ascension St. John - Owasso
Owasso, OK
Ascension St. John - Sapulpa
Sapulpa, OK
Ascension St. John Hospital - Broken Arrow
Broken Arrow, OK
Locations: Hours: Languages:
ST. JOHN BROKEN ARROW
EMERGENCY DEPT
1000 W BOISE CIRCLE
BROKEN ARROW OK 74012

Phone #: (918) 994-8080
Fax #:
Mon:
Tue:
Wed:
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10221 E. 81st ST.
Tulsa, OK 74133

Phone #: (918) 252-9300
Fax #: (4) 200-
Mon:
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Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
ALFRED W GARTZKE PA 854
KALLIE BLYTHE HUMPHREYS PA 2188

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