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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST

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PHILLIPS, MICHAEL RAY       
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: ASCENSION MEDICAL GROUP ST. JOHN CVT SURGERY
1923 S. UTICA AVE
SIEGFRIED TOWER
TULSA OK 74104

Address last updated on 10/21/2024
Phone #: (918) 712-3366
Fax #:
County: TULSA
License: 29306
Dated: 7/9/2012
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: SURGERY, CARDIOVASCULAR
Other Specialty
SURGERY, THORACIC
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: UNIV OF MO, COLUMBIA SCH OF MED, COLUMBIA MO 65212
Graduated: 6 / 1993
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 SURGERY (Surgery specific)
AMERICAN BOARD OF THORACIC SURGERY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Hillcrest Hospital South (fmly SouthCrest)
Tulsa, OK
Hillcrest Medical Center
Tulsa, OK
Locations: Hours: Languages:
ASCENSION MEDICAL GROUP ST. JOHN CVT SURGERY
1923 S. UTICA AVE
SIEGFRIED TOWER
TULSA OK 74104

Phone #: (918) 712-3366
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
RYAN BELLASSAI PA 4780
ANDREW BOWMAN PA 4852
VICTORIA ANN BROOKS PA 2830
TANNER LEE COOK PA 5047
CAMRYN DYAN CORWIN PA 4943
ANDREW FINLEY APRN 109952
LAURA KATHRYN HOLMAN PA 2726
VICKI LEIST APRN 83523
JAMIE SCOTT TEETER PA 2005

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