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GROSSERODE, TAMMY JEAN       
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: DERMATOLOGY CLINIC
6565 SOUTH YALE
SUITE 503
TULSA OK 74136

Address last updated on 12/30/2004
Phone #: (918) 494-8333
Fax #:
County: TULSA
License: 1012
Dated: 3/8/2000
Expires: 3/31/2005
Temp. Ltr. Issued: 1/20/2000
Temp. Ltr. Expires: 3/11/2000
License Type: Physician Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
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.
Locations: Hours: Languages:
DERMATOLOGY CLINIC
6565 SOUTH YALE
SUITE 503
TULSA OK 74136

Phone #: (918) 494-8333
Fax #:

Hospital Privileges:

None listed

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