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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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BERGQUIST, JOHN RANDOL       
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
1145 S UTICA PARK AVE
SUITE 701
TULSA OK 74104

Address last updated on 6/3/2024
Phone #: (918) 582-6544
Fax #:
County: TULSA
License: 38503
Dated: 8/27/2021
Expires: 8/1/2025
License Type: Medical Doctor
Specialty: General Surgery
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Md Sch Of Med, Baltimore Md 21201
Graduated: 5 / 2012
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 SURGERY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: Hillcrest Medical Center
Tulsa, OK
Locations: Hours: Languages:
UTICA PARK CLINIC
1145 S UTICA PARK AVE
SUITE 701
TULSA OK 74104

Phone #: (918) 582-6544
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:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
SAMANTHA KUPLICKI APRN 101047
SUSANNA MCDANIEL APRN 82443
MARY KATHERINE NELSON PA 2957
JENNA ALEXIS SPECHT PA 3223
SUMA THOMAS APRN 84249
ANDREA WALL APRN 86862

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