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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 3:47 AM CST
Next Update: Friday, November 22, 2024 12:00 PM CST

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RODGERS, JACKSON       
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: SSM ST. ANTHONY'S MIDWEST CITY HOSPITAL
2825 PARK LAWN DRIVE
MIDWEST CITY OK 73110

Address last updated on 3/11/2024
Phone #: (405) 610-4411
Fax #:
County: OKLAHOMA
License: 4644
Dated: 9/7/2021
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:
SSM ST. ANTHONY'S MIDWEST CITY HOSPITAL
2825 PARK LAWN DRIVE
MIDWEST CITY OK 73110

Phone #: (405) 610-4411
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
HERSCHEL LAWRENCE BROWN MD 18034
CARLOS CABRERA DO 5196
CHARLES GARRIOTT DO 5168
MARTY MCBEE DO 3036
JOSH ERIC MCWILLIAMS MD 23717
STEPHEN KOJI SPARKS DO 4559
STEPHANIE JAYNE TOTH MD 25091
Matthew Wood DO 5841

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