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Oklahoma Board of Medical Licensure and Supervision

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IVY, CHARLES 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: EDMOND SPECIALTY HOSPITAL
1100 EAST 9TH
EDMOND OK 73034

Address last updated on 9/14/2006
Phone #: (405) 341-8150
Fax #:
County: OKLAHOMA
License: 2729
Dated: 9/14/2006
Expires: 9/30/2010
Temp. Ltr. Issued: 8/7/2006
Temp. Ltr. Expires: 9/23/2006
License Type: Respiratory Care Practitioner
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year: 0
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:
EDMOND SPECIALTY HOSPITAL
1100 EAST 9TH
EDMOND OK 73034

Phone #: (405) 341-8150
Fax #:

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