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STACY, JOHN LEE JR.       
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: 217 CHURCH ST.
WAGONER OK 74467
Phone #:
Fax #:
County: WAGONER
License: 251
Dated: 10/5/1979
Expires: 3/31/1987
License Type: Physician Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year:
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:
217 CHURCH ST.
WAGONER OK 74467

Phone #:
Fax #:

Hospital Privileges:

None listed

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