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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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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: 4140 W MEMORAL RD #208
OKLAHOMA CITY OK 73120

Address last updated on 6/5/2024
Phone #: (405) 749-4230
Fax #: (405) 749-4228
County: OKLAHOMA
License: 23047
Dated: 8/2/2004
Expires: 8/1/2025
License Type: Medical Doctor
Specialty: Urology
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 2002
CME Year: 2025
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 UROLOGY
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: Mercy Hospital OKC
Oklahoma City, OK
Oklahoma Surgicare
Oklahoma City, OK
Locations: Hours: Languages:
4140 W MEMORAL RD #208
OKLAHOMA CITY OK 73120

Phone #: (405) 749-4230
Fax #: (405) 749-4228
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
KATHRYN MARIE FEISAL PA 2251
KELBY SUNARTO APRN 108296
DALE TITSWORTH APRN 19785
BREANNA WHITE APRN 81293

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