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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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ITEN, MICHAEL JEROME       
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: WC SPRINGER CLINIC UC
6160 S YALE AVE
TULSA OK 74136

Address last updated on 5/29/2024
Phone #: (918) 495-2600
Fax #: (918) 497-3007
County: TULSA
License: 2274
Dated: 7/25/2013
Expires: 3/31/2025
Temp. Ltr. Issued: 7/11/2013
Temp. Ltr. Expires: 7/25/2013
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:
WC SPRINGER CLINIC UC
6160 S YALE AVE
TULSA OK 74136

Phone #: (918) 495-2600
Fax #: (918) 497-3007

Hospital Privileges:

St. Francis Hospital
Tulsa, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
DANA KRISTINE DAVIS MD 20792
SCOTT THOMAS DULL MD 26851
NAINA LYNN GROSS MD 25071
Kristin Huntoon DO 7888
DANYA JOSSERAND DO 5876
Travis J. Small DO 6499

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