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Oklahoma Board of Medical Licensure and Supervision

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MENDOZA, FRED PANGANIBAN       
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: OUHSC DEPT OF INTERNAL MEDICINE
4502 EAST 41ST STREET
TULSA OK 74135-2553

Address last updated on 7/17/2003
Phone #:
Fax #:
County: TULSA
License: 22489
Dated: 7/17/2003
Expires: 7/1/2004
License Type: Medical Doctor
Specialty: Internal Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Manila Central Univ, Coll Of Med, Caloocan City, Rizal, Philippines
Graduated: 4 / 1984
CME Year: 2006
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:
OUHSC DEPT OF INTERNAL MEDICINE
4502 EAST 41ST STREET
TULSA OK 74135-2553

Phone #:
Fax #:

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