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BLACK, MATTHEW JOHN
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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.
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| Practice Address: |
COMMUNITY HOME HEATH
1486 S. ELLIOT
CLAREMORE OK 74019
Address last updated on 1/13/2015 |
| Phone #: |
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| Fax #: |
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| County: |
OKLAHOMA |
| License: |
4036 |
| Dated: |
8/31/2007 |
| Expires: |
1/31/2016 |
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Temp.
Ltr.
Issued:
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5/31/2007 |
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Temp.
Ltr.
Expires:
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9/22/2007 |
| License Type: |
Physical Therapist |
| Specialty: |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| CME Year: |
2016 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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