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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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DAVIS, MARK LEROY       
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: ST ANTHONY PHYSICIANS SHAWNEE
PO BOX 849
3315 KETHLEY ROAD
SHAWNEE OK 74804

Address last updated on 2/17/2024
Phone #: (405) 273-5801
Fax #: (405) 878-3805
County: POTTAWATOMIE
License: 801
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: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
ST ANTHONY PHYSICIANS SHAWNEE
PO BOX 849
3315 KETHLEY ROAD
SHAWNEE OK 74804

Phone #: (405) 273-5801
Fax #: (405) 878-3805

Hospital Privileges:

SSM Health St. Anthony Shawnee Hospital (fmly Unity Health Ctr)
Shawnee, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
ANGELO ARGENTO MD 24716
GREGORY LEE BLAIR MD 19544
MICHAEL WAYNE BUTCHER MD 14277
PHILLIP ANTHONY HADDAD MD 17395
KIMBERLY KAYE HANIGAR MD 18949
DAVID LEE HOLLAND JR MD 17426
JEREMY P HOLTER MD 22964
KELLI DENISE KOONS MD 22002
ADAM VAIL STEPHENS MD 24050
H STAN WOOD DO 2406

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