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JACK, SAMUEL CORWIN       
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: 5011 SW COUNTRY CLUB DR
LAWTON OK 73505-6830

Address last updated on 12/23/1999
Phone #:
Fax #:
County: COMANCHE
License: 7114
Dated: 6/8/1955
Expires: 6/1/1997
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Status: Inactive
Status Class: Retired
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: / 1955
CME Year:
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 ORTHOPAEDIC SURGERY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
5011 SW COUNTRY CLUB DR
LAWTON OK 73505-6830

Phone #:
Fax #:

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