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JACOBSEN, MATTHEW WARREN       
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: GREAT PLAINS FAMILY PRACTICE
3500 NW 56TH #100
OKLAHOMA CITY OK 73112

Address last updated on 9/17/2003
Phone #: (405) 951-2858
Fax #:
County: OKLAHOMA
License: 22908
Dated: 7/17/2003
Expires: 7/1/2005
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ne Coll Of Med, Omaha Ne 68198
Graduated: 5 / 2002
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: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: Lindsay Municipal Hospital
Lindsay, OK
Locations: Hours: Languages:
GREAT PLAINS FAMILY PRACTICE
3500 NW 56TH #100
OKLAHOMA CITY OK 73112

Phone #: (405) 951-2858
Fax #:
Mon: 8:30AM - 5:00PM
Tue: 8:30AM - 5:00PM
Wed: 8:30AM - 5:00PM
Thu: 8:30AM - 5:00PM
Fri: 8:30AM - 5:00PM
Sat: Closed
Sun: Closed
4028 NW 29
Oklahoma City, OK 73107

Phone #:
Fax #:

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