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GREEN, MACK CRAWFORD IV       
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: UNIVERSITY OF OKLAHOMA
900 NE 10TH STREET
OKLAHOMA CITY OK 73104

Address last updated on 8/29/2014
Phone #: (405) 271-4311
Fax #:
County: OKLAHOMA
License: 27676
Dated: 7/1/2012
Expires: 7/1/2014
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Ross Univ, Sch of Med, Roseau, Dominica
Graduated: 8 / 2008
CME Year: 2015
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:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
UNIVERSITY OF OKLAHOMA
900 NE 10TH STREET
OKLAHOMA CITY OK 73104

Phone #: (405) 271-4311
Fax #:

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