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HINE, JERRY RANDAL       
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: 4200 UNIVERSITY AVE SUITE 300
WEST DES MOINES IA 50266

Address last updated on 6/26/2023
Phone #: (405) 474-0195
Fax #:
County: NOT OKLAHOMA
License: 34255
Dated: 11/16/2018
Expires: 11/1/2021
License Type: Medical Doctor
Specialty: Anesthesiology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 2008
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 ANESTHESIOLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: INTEGRIS Bass Baptist Health Center
Enid, OK
Locations: Hours: Languages:
4200 UNIVERSITY AVE SUITE 300
WEST DES MOINES IA 50266

Phone #: (405) 474-0195
Fax #:
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600 S Monroe St
Enid, OK 73701

Phone #: (405) 474-0195
Fax #: (4) 201-
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