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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: 11010 S HUDSON AVENUE
TULSA OK 74137

Address last updated on 3/30/2023
Phone #: (617) 710-7466
Fax #:
County: TULSA
License: 29695
Dated: 4/12/2013
Expires: 4/1/2023
License Type: Medical Doctor
Specialty: Nephrology
Internal Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ of TX at San Antonio, UTSA Long School of Medicine
Graduated: 5 / 1997
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 INTERNAL MEDICINE
AMERICAN BOARD OF INTERNAL MEDICINE - Nephrology
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
11010 S HUDSON AVENUE
TULSA OK 74137

Phone #: (617) 710-7466
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:

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