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MANLY, TARA LAURINE       
Practice Address: THE BROADWAY CLINIC
1801 N BROADWAY AVENUE
OKLAHOMA CITY OK 73103

Address last updated on 6/25/2009
Phone #: (405) 528-1936
Fax #:
County: OKLAHOMA
License: 1755
Dated: 10/17/2008
Expires: 3/31/2010
Temp. Ltr. Issued: 7/18/2008
Temp. Ltr. Expires: 11/7/2008
License Type: Physician Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year: 0
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:
THE BROADWAY CLINIC
1801 N BROADWAY AVENUE
OKLAHOMA CITY OK 73103

Phone #: (405) 528-1936
Fax #:

Hospital Privileges:

None listed

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