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Oklahoma Board of Medical Licensure and Supervision

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SHORT, RANDE KENT       
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: SOUTHWEST OKLAHOMA FAMILY PRACTICE RESIDENCY
4427 WEST GORE BLVD
LAWTON OK 73505-5907

Address last updated on 5/28/2009
Phone #: (580) 248-2280
Fax #:
County: COMANCHE
License: 21731
Dated: 8/30/2000
Expires: 8/1/2003
Temp. Lic. Issued: 8/11/2000
Temp. Lic. Expires: 8/30/2000
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Colorado Sch Of Med (frmly in Denver)
Graduated: 5 / 1980
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: AMERICAN BOARD OF FAMILY MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
SOUTHWEST OKLAHOMA FAMILY PRACTICE RESIDENCY
4427 WEST GORE BLVD
LAWTON OK 73505-5907

Phone #: (580) 248-2280
Fax #:

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