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Next Update: Thursday, December 19, 2024 2:50 AM CST
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FAN, ELLEN
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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.
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| Practice Address: |
17194 PRESTON ROAD
SUITE 102 BOX 242
DALLAS TX 75248-1221
Address last updated on 10/19/2005 |
| Phone #: |
(972) 735-0183 |
| Fax #: |
(972) 735-0184 |
| County: |
NOT OKLAHOMA |
| License: |
24158 |
| Dated: |
10/8/2004 |
| Expires: |
10/1/2006 |
| License Type: |
Medical Doctor |
| Specialty: |
Psychiatry
Geriatric Psychiatry |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Univ of TX at San Antonio, UTSA Long School of Medicine |
| Graduated: |
5 /
1998 |
| CME Year: |
2007 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY |
| New Patients: |
Contact licensee |
| Medicaid: |
Contact licensee |
| Medicare: |
Contact licensee |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
None listed |
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