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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, December 23, 2024 6:44 PM CST
Next Update: Tuesday, December 24, 2024 2:50 AM CST

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CLARK, JONATHAN DAVID       
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: EASTERN OK AVE HEALTH CARE SP
1011 HONOR HEIGHT DR
MUSKOGEE OK 74401

Address last updated on 2/16/2024
Phone #: (918) 577-4164
Fax #:
County: MUSKOGEE
License: 3141
Dated: 2/11/2020
Expires: 3/31/2025
Temp. Ltr. Issued: 1/13/2020
Temp. Ltr. Expires: 3/5/2020
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:
EASTERN OK AVE HEALTH CARE SP
1011 HONOR HEIGHT DR
MUSKOGEE OK 74401

Phone #: (918) 577-4164
Fax #:

Hospital Privileges:

Jack C. Montgomery VA Medical Center
Muskogee, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
MARK ALFORD RANDEL MD 16951

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