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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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KOCH, TODD       
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: OU HEALTH PHYSICIANS CANYON PARK FAMILY MEDICINE
1501 E 19TH STREET
EDMOND OK 73013

Address last updated on 12/3/2024
Phone #: (405) 348-6611
Fax #: (405) 348-9280
County: OKLAHOMA
License: 5067
Dated: 8/17/2023
Expires: 3/31/2025
Temp. Ltr. Issued: 6/27/2023
Temp. Ltr. Expires: 9/14/2023
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:
OU HEALTH PHYSICIANS CANYON PARK FAMILY MEDICINE
1501 E 19TH STREET
EDMOND OK 73013

Phone #: (405) 348-6611
Fax #: (405) 348-9280

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
ELIZABETH MICHEL NELSON MD 31582
FLOYD KEITH UNDERHILL MD 14384

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