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Oklahoma Board of Medical Licensure and Supervision

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CONRAD, ERICA LANE       
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: UNITED STATES AIR FORCE
7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK 73145

Address last updated on 4/16/2018
Phone #: (405) 734-2778
Fax #:
County: OKLAHOMA
License: 31207
Dated: 5/4/2015
Expires: 5/1/2019
License Type: Medical Doctor
Specialty: Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: ST LOUIS UNIV SCH OF MED, ST LOUIS MO 63104
Graduated: 5 / 2011
CME Year: 2021
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 FAMILY MEDICINE
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
UNITED STATES AIR FORCE
7050 AIR DEPOT BLVD BLDG 1094
TINKER AFB OK 73145

Phone #: (405) 734-2778
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
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