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CUSTIS, DAVID KENNETH       
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: BLUE STEM CLINIC
224 S E DEBELL AVENUE
BARTLESVILLE OK 74006
Phone #:
Fax #:
County: WASHINGTON
License: 773
Dated: 6/17/1996
Expires: 3/31/1999
Temp. Ltr. Issued: 4/18/1996
Temp. Ltr. Expires: 7/27/1996
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:
BLUE STEM CLINIC
224 S E DEBELL AVENUE
BARTLESVILLE OK 74006

Phone #:
Fax #:

Hospital Privileges:

None listed

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