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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 1:58 PM CST
Next Update: Friday, November 22, 2024 4:30 PM CST

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JOHNSON, MARK DANIEL       
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: OKLAHOMA SPORTS & ORTHOPEDIC INSTITUTE
13401 N. WESTERN AVE. SUITE 101
OKLAHOMA CITY OK 73134

Address last updated on 3/12/2024
Phone #: (405) 478-7111
Fax #: (405) 478-7112
County: OKLAHOMA
License: 485
Dated: 9/6/1986
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:
OKLAHOMA SPORTS & ORTHOPEDIC INSTITUTE
13401 N. WESTERN AVE. SUITE 101
OKLAHOMA CITY OK 73134

Phone #: (405) 478-7111
Fax #: (405) 478-7112

Hospital Privileges:

Community Hospital - OKC
Oklahoma City, OK
Mercy Hospital OKC
Oklahoma City, OK
Northwest Surgical Hospital
Oklahoma City, OK
SSM Health Bone and Joint Hospital at St. Anthony
Oklahoma City, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
JAMES LEE BOND MD 21989
SCOTT MARTIN DE LA GARZA MD 21981
TIMOTHY MICHAEL GEIB MD 22888
RICHARD ALAN KIRKPATRICK MD 22376
COREY EUGENE PONDER MD 22884

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