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Oklahoma Board of Medical Licensure and Supervision

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ROACH, DILLON JACK       
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: INTEGRIS BAPTSIT MEDICAL CENTER
3300 NW EXPRESSWAY
OKLAHOMA CITY OK 73112

Address last updated on 6/7/2023
Phone #: (405) 949-3011
Fax #:
County: OKLAHOMA
License: 26891
Dated: 3/16/2009
Expires: 3/1/2025
License Type: Medical Doctor
Specialty: Emergency Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 2006
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 EMERGENCY MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: INTEGRIS Baptist Medical Center
Oklahoma City, OK
INTEGRIS Health Ponca City Hospital -(frmly Via Christi)
Ponca City, OK
Mercy Hospital OKC
Oklahoma City, OK
St. Mary's Regional Medical Center
Enid, OK
Locations: Hours: Languages:
INTEGRIS BAPTSIT MEDICAL CENTER
3300 NW EXPRESSWAY
OKLAHOMA CITY OK 73112

Phone #: (405) 949-3011
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
ELIZABETH DISALVATORE PA 4688
NATHAN WAYNE FITE PA 2309
ADAM HELM APRN 120496
TAYLOR BROOKE HERZER PA 2937
KALLIE BLYTHE HUMPHREYS PA 2188
CRYSTAL AMY MAHANA PA 2955

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