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ICAZA, EDWARD EARL       
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: 2920 KATY FREEWAY
SUITE 405
KATY TX 77494

Address last updated on 10/28/2011
Phone #: (832) 437-8375
Fax #: (832) 437-2813
County: NOT OKLAHOMA
License: 26567
Dated: 8/12/2008
Expires: 8/1/2012
License Type: Medical Doctor
Specialty: Neurology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1996
CME Year: 2014
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 PSYCHIATRY AND NEUROLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Norman Regional Hospital
Norman, OK
Locations: Hours: Languages:
2920 KATY FREEWAY
SUITE 405
KATY TX 77494

Phone #: (832) 437-8375
Fax #: (832) 437-2813
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:

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