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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, December 21, 2024 3:49 AM CST
Next Update: Saturday, December 21, 2024 12:00 PM CST

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GREEN, PHIL JAMES       
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: 223 EAST BLACKWELL
BLACKWELL OK 74631

Address last updated on 2/11/2024
Phone #: (580) 363-0943
Fax #: (580) 363-0930
County: KAY
License: 800
Dated: 12/26/1996
Expires: 3/31/2025
Temp. Ltr. Issued: 8/1/1996
Temp. Ltr. Expires: 8/1/1997
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
8/26/2024 Completed all requirements ordered by the Board
9/15/2022 Voluntary Submittal to Jurisdiction
1/12/2022 Complaint Citation
Board Filings and/or Orders:
09/15/2022
01/12/2022
01/12/2022
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
223 EAST BLACKWELL
BLACKWELL OK 74631

Phone #: (580) 363-0943
Fax #: (580) 363-0930

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
MELINDA ALLEN DO 3741
Tammy K. Jarvis DO 3915

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