POLK, KEVIN DWAYNE - Licensee Information

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POLK, KEVIN DWAYNE

Practice Address:	RYAN MEDICAL CLINIC 514 WASHINGTON RYAN OK 73565 Address last updated on 5/6/2005
Phone #:	(580) 757-2224
Fax #:
County:	JEFFERSON
License:	1442
Dated:	5/5/2005
Expires:	3/31/2007
Temp. Ltr. Issued:	3/10/2005
Temp. Ltr. Expires:	5/7/2005
License Type:	Physician Assistant
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:
RYAN MEDICAL CLINIC 514 WASHINGTON RYAN OK 73565 Phone #: (580) 757-2224 Fax #:

Hospital Privileges:

None listed

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Oklahoma State Board of Medical Licensure and Supervision :: 101 NE 51st St, Oklahoma City, OK 73105-1821
Main Number: (405) 962-1400 :: Fax: (405) 962-1440 :: Complaints outside 405 area code: 1-800-381-4519
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