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Last Update: Monday, November 4, 2024 3:36 AM CST
Next Update: Monday, November 4, 2024 12:00 PM CST
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GILLEN, MARK RICHARD
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| Practice Address: |
6160 SOUTH YALE
TULSA OK 74136
Address last updated on 2/23/2024 |
| Phone #: |
(918) 495-2600 |
| Fax #: |
|
| County: |
TULSA |
| License: |
1178 |
| Dated: |
4/1/2002 |
| Expires: |
3/31/2025 |
|
Temp.
Ltr.
Issued:
|
12/20/2001 |
|
Temp.
Ltr.
Expires:
|
3/31/2002 |
| License Type: |
Physician Assistant |
| Specialty: |
|
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
|
| CME Year: |
2025 |
|
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
|
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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Hospital Privileges:
None listed
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Primary Supervisor(s):
|
| Name: |
Type: |
License Number: |
Full/Part Time: |
|
DANA KRISTINE DAVIS
|
MD |
20792 |
|
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