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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST
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FULLER, PHILLIP TYLER
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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.
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| Practice Address: |
1921 STONECIPHER BLVD
ADA OK 74820
Address last updated on 3/21/2024 |
| Phone #: |
(580) 421-4531 |
| Fax #: |
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| County: |
PONTOTOC |
| License: |
30483 |
| Dated: |
3/6/2014 |
| Expires: |
3/1/2025 |
| License Type: |
Medical Doctor |
| Specialty: |
Urology |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Univ Of Ok Coll Of Med, Oklahoma City Ok 73190 |
| Graduated: |
5 /
2009 |
| CME Year: |
2026 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF UROLOGY |
| New Patients: |
Yes |
| Medicaid: |
Yes |
| Medicare: |
Yes |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
Chickasaw Nation Medical Ctr (fmly Carl Albert Indian Health Facility-IHS)
Ada, OK
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| Locations: |
Hours: |
Languages: |
1921 STONECIPHER BLVD
ADA OK 74820
Phone #:
(580) 421-4531
Fax #:
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Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 12:00PM
Sat:
Sun: |
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