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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST
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GILLEN, MARK RICHARD
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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.
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| Practice Address: |
6160 SOUTH YALE
TULSA OK 74136
Address last updated on 2/23/2024 |
| Phone #: |
(918) 495-2600 |
| Fax #: |
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| County: |
TULSA |
| License: |
1178 |
| Dated: |
4/1/2002 |
| Expires: |
3/31/2025 |
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Temp.
Ltr.
Issued:
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12/20/2001 |
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Temp.
Ltr.
Expires:
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3/31/2002 |
| License Type: |
Physician Assistant |
| Specialty: |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| 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):
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| Name: |
Type: |
License Number: |
Full/Part Time: |
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DANA KRISTINE DAVIS
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MD |
20792 |
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