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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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HOLLER, BENJAMIN       
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: FAMILY MEDICINE
12142 S YUKON AVE
GLENPOOL OK 73033

Address last updated on 7/12/2024
Phone #:
Fax #:
County: TULSA
License: 38874
Dated: 5/30/2024
Expires: 3/1/2025
License Type: Medical Doctor
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
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:
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
FAMILY MEDICINE
12142 S YUKON AVE
GLENPOOL OK 73033

Phone #:
Fax #:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
CARISSA MICHELLE LAWSON PA 2568

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