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Oklahoma Board of Medical Licensure and Supervision

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FETZER, JACK DEFOREST       
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: 1919 18TH
P O BOX 669
WOODWARD OK 73802-0669
Phone #:
Fax #:
County: WOODWARD
License: 6233
Dated: 1/18/1952
Expires: 1/1/2000
License Type: Medical Doctor
Specialty: Family Medicine
General Surgery
Status: Inactive
Status Class: Deceased
Restricted to:
Registered to Dispense: YES
Medical School: Baylor Coll Of Med, Houston Tx 77030
Graduated: / 1948
CME Year: 2001
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: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
1919 18TH
P O BOX 669
WOODWARD OK 73802-0669

Phone #:
Fax #:

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