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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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DAVE, MAYANK NANDKISHOR       
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: 3401 W. GORE BLVD
HOSPITALIST GROUP
LAWTON OK 73505

Address last updated on 8/14/2024
Phone #: (580) 510-7037
Fax #: (580) 510-7038
County: COMANCHE
License: 25648
Dated: 7/1/2009
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Tver State Med Academy, Tver, Russia
Graduated: 6 / 2001
CME Year: 2027
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 FAMILY MEDICINE
New Patients: Yes
Medicaid: No
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: Comanche County Memorial Hospital
Lawton, OK
Locations: Hours: Languages:
3401 W. GORE BLVD
HOSPITALIST GROUP
LAWTON OK 73505

Phone #: (580) 510-7037
Fax #: (580) 510-7038
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Tue:
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1612 W Gore Blvd
Lawton, OK 73501

Phone #: (580) 280-2201
Fax #: (1) 202-
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Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
JEFFERY BARLOW APRN 83548
COTY BARLOW APRN 89488
YUMEE BODENHAMER APRN 89289
BRENT BYERS APRN 69144
FABIAN GALLEGOS APRN 106503
ANGELA LYNN GIBBONS PA 4445
INGRID GUTIERREZ APRN 15133
CRYSTAL AMY MAHANA PA 2955
LAURA MILLER APRN 87656
AMBER MORROW APRN 73704
LAUREN DANIELLE UKLEYA PA 4461
DARBI WILLIAMS APRN 110449
APRIL ZUMWALT APRN 105645

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