Search Results
Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST
Return to Search Licensees page
|
JACK, RANDALL ELLIS
|
|
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: |
310 NORTHCREST DRIVE
SPRINGFIELD TN 37172
Address last updated on 8/13/2004 |
| Phone #: |
(615) 384-4496 |
| Fax #: |
|
| County: |
NOT OKLAHOMA |
| License: |
23099 |
| Dated: |
7/1/2002 |
| Expires: |
7/1/2004 |
| License Type: |
Medical Doctor |
| Specialty: |
Obstetrics & Gynecology |
|
| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
|
| Registered to Dispense: |
YES |
| Medical School: |
Univ Of Nv Sch Of Med, Reno Nv 89557 |
| Graduated: |
5 /
2000 |
| CME Year: |
2005 |
|
|
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: |
BlueChoice PPO
Preferred Community Choice
Welcor/Sooner |
| Hospital Privileges: |
OU Health Medical Center
Oklahoma City, OK
|
|
| Locations: |
Hours: |
Languages: |
310 NORTHCREST DRIVE
SPRINGFIELD TN 37172
Phone #:
(615) 384-4496
Fax #:
|
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 |
Spanish |
|
|
|
Return to Search Licensees page
