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CORDELL, CRYSTAL STARDUST       
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: PRIMEPATH
1874 BELTLINE RD SW
DECATUR AL 35601

Address last updated on 9/20/2015
Phone #: (251) 401-0035
Fax #:
County: NOT OKLAHOMA
License: 31885
Dated: 11/4/2015
Expires: 11/1/2016
Temp. Lic. Issued: 10/15/2015
Temp. Lic. Expires: 1/15/2016
License Type: Medical Doctor
Specialty: Anatomic/Clinical Pathology
Cytopathology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: UNIV OF SOUTH AL COLL OF MED, MOBILE AL 36688
Graduated: 5 / 2010
CME Year: 2018
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 PATHOLOGY (Anatomic/Clinical)
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
PRIMEPATH
1874 BELTLINE RD SW
DECATUR AL 35601

Phone #: (251) 401-0035
Fax #:

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