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Oklahoma Board of Medical Licensure and Supervision

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GILLIAM, MARY ANN       
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: 14719 CO RD 3585
ADA OK 74820-3063

Address last updated on 5/22/2003
Phone #: (580) 436-6422
Fax #: (580) 436-1795
County: PONTOTOC
License: 9089
Dated: 6/11/1969
Expires: 6/1/2007
License Type: Medical Doctor
Specialty: Legal Medicine
Pediatrics
Family Medicine
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 5 / 1968
CME Year: 2007
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
5/11/2000 Probation
10/1/1993 Probation Ended
10/26/1990 Probation
10/10/1987 Probation Ended
9/16/1985 Suspension, License
9/22/1984 Probation
Board Filings and/or Orders:
05/11/2000
05/10/1996
03/23/1996
01/19/1996
09/16/1995
10/01/1993
11/01/1991
10/26/1990
05/18/1984
05/18/1984
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:
14719 CO RD 3585
ADA OK 74820-3063

Phone #: (580) 436-6422
Fax #: (580) 436-1795

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