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Oklahoma Board of Medical Licensure and Supervision

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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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THENMADATHIL, MERRY MATHEW       
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: PEDIATRIC ENT OF OKLAHOMA
9900 BROADWAY EXT
STE 200
OKLAHOMA CITY OK 73114

Address last updated on 11/13/2024
Phone #: (405) 608-8833
Fax #: (405) 608-8188
County: OKLAHOMA
License: 1857
Dated: 1/14/2010
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
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:
PEDIATRIC ENT OF OKLAHOMA
9900 BROADWAY EXT
STE 200
OKLAHOMA CITY OK 73114

Phone #: (405) 608-8833
Fax #: (405) 608-8188

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
GERMAN PAUL DIGOY MD 24270
ROBERT SCOTT GLADE MD 26967
JOHN ROLAND HOUCK MD 17455
JOSE ANTONIO SANCLEMENT MD 25575
Margo Rose Tanghetti DO 6262
NILESH RAMAN VASAN MD 23030
IVAN WAYNE MD 22995
ELENA BETH WOODSON MD 31155

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