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Oklahoma Board of Medical Licensure and Supervision

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CHISHOLM, ROBERT MILES III       
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: SOUTHWESTERN MEDICAL CENTER
605 W GORE #6
LAWTON OK 73501

Address last updated on 10/29/2011
Phone #: (580) 353-1616 x15
Fax #: (580) 353-0052
County: COMANCHE
License: 22563
Dated: 11/8/2001
Expires: 11/1/2012
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1996
CME Year: 2013
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
7/25/2013 Revoked License
4/23/2013 Complaint Citation
Board Filings and/or Orders:
08/02/2013
05/10/2013
02/08/2013
02/08/2013
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna PPO
BlueChoice PPO
BlueLincs HMO
CIGNA PPO
HealthChoice
Preferred Community Choice
SoonerCare HMO
SoonerCare PPO
United Healthcare Options PPO
Hospital Privileges: None listed
Locations: Hours: Languages:
SOUTHWESTERN MEDICAL CENTER
605 W GORE #6
LAWTON OK 73501

Phone #: (580) 353-1616 x15
Fax #: (580) 353-0052
Mon: 8:30AM - 5:00PM
Tue: 8:30AM - 5:00PM
Wed: 8:30AM - 5:00PM
Thu: 8:30AM - 5:00PM
Fri: 8:30AM - 12:00PM
Spanish

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