ANDERSON, BLAKE LEW - Licensee Information

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

ANDERSON, BLAKE LEW

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:	UTICA PARK CLINIC ENT SOUTH 9001 S 101ST EAST AVE SUITE 280 TULSA OK 74133-5711 Address last updated on 6/13/2024
Phone #:	(918) 459-8824
Fax #:	(918) 307-2239
County:	TULSA
License:	34046
Dated:	7/16/2018
Expires:	7/1/2025
License Type:	Medical Doctor
Specialty:	Otolaryngology

Status:	Active
Status Class:	Fully Licensed
Restricted to:
Registered to Dispense:	YES
Medical School:	Columbia Univ Coll Of Physicians And Surgeons, New York Ny 10032
Graduated:	5 / 1998
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 OTOLARYNGOLOGY
New Patients:	Yes
Medicaid:	Yes
Medicare:	Yes

HMO/PPO:	None listed
Hospital Privileges:	Hillcrest Hospital Cushing (fmly Cushing Reg. Hosp.) Cushing, OK Hillcrest Medical Center Tulsa, OK Hillcrest Specialty Hospital Tulsa, OK

Locations:	Hours:	Languages:
UTICA PARK CLINIC ENT SOUTH 9001 S 101ST EAST AVE SUITE 280 TULSA OK 74133-5711 Phone #: (918) 459-8824 Fax #: (918) 307-2239	Mon: 8:00AM - 5:00PM Tue: 8:00AM - 5:00PM Wed: 8:00AM - 5:00PM Thu: 8:00AM - 5:00PM Fri: 8:00AM - 5:00PM Sat: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
MONICA D BROUSSARD	PA	2365
VIRGINIA JULIAN CORCORAN	PA	2859

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