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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.
Practice Address: ALLIANCE HEALTH PONCA CITY
415 FAIRVIEW
STE 202
PONCA CITY OK 74604

Address last updated on 2/4/2022
Phone #: (620) 515-3630
Fax #:
County: KAY
License: 34598
Dated: 4/12/2019
Expires: 4/1/2023
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Adult Reconstructive Orthopedics
Orthopedic Trauma
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Trichur Med Coll, Calicut Univ, Trichur, Kerala, India
Graduated: 10 / 1997
CME Year: 2025
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:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
ALLIANCE HEALTH PONCA CITY
415 FAIRVIEW
STE 202
PONCA CITY OK 74604

Phone #: (620) 515-3630
Fax #:
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:

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