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Oklahoma Board of Medical Licensure and Supervision

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RUSSELL, GREGORY ALAN       
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. ANTHONY FAMILY PRACTICE RESIDENCY
608 NORTHWEST 9TH STREET #1000
OKLAHOMA CITY OK 73102

Address last updated on 9/15/2003
Phone #: (405) 272-7494
Fax #: (405) 271-6985
County: OKLAHOMA
License: 23007
Dated: 9/15/2003
Expires: 9/1/2005
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of South Fl Coll Of Med, Tampa Fl 33612
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: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna HMO
Aetna PPO
BlueChoice PPO
BlueLincs HMO
HealthChoice
PacifiCare of Oklahoma, Inc
Prudential Health Care Plan, Inc
UniCare Health Plans of Oklahoma
United Healthcare HMO
United Healthcare Options PPO
Hospital Privileges: None listed
Locations: Hours: Languages:
ST. ANTHONY FAMILY PRACTICE RESIDENCY
608 NORTHWEST 9TH STREET #1000
OKLAHOMA CITY OK 73102

Phone #: (405) 272-7494
Fax #: (405) 271-6985
Mon: 7:00AM - 6:00PM
Tue: 7:00AM - 6:00PM
Wed: 7:00AM - 6:00PM
Thu: 7:00AM - 6:00PM
Fri: 7:00AM - 6:00PM

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