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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 6:42 PM CST
Next Update: Saturday, November 23, 2024 2:50 AM CST

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LANDIS, DEREK TODD       
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: MERCY KIDS ARDMORE
731 NW 12TH
SUITE 104
ARDMORE OK 73401

Address last updated on 6/3/2024
Phone #: (580) 223-5311
Fax #: (580) 223-8227
County: CARTER
License: 25666
Dated: 7/1/2007
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: Pediatrics
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: U of Miami L M Miller, SOM, Miami, FL 33101
Graduated: 5 / 2004
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 PEDIATRICS
New Patients: Yes
Medicaid: Yes
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Mercy Memorial Health Center, Inc. - Ardmore
Ardmore, OK
Locations: Hours: Languages:
MERCY KIDS ARDMORE
731 NW 12TH
SUITE 104
ARDMORE OK 73401

Phone #: (580) 223-5311
Fax #: (580) 223-8227
Mon: 8:00AM - 5:00PM
Tue: 7:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 7:00AM - 5:00PM
Fri: 8:00AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
JERRI LYNN BRADSHAW PA 1402
SCOTT ALLEN COOPER PA 2044

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