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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, May 6, 2024 9:28 AM CDT
Next Update: Monday, May 6, 2024 12:00 PM CDT

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MOORE, MATTHEW HENRY
Practice Address: GRAND LAKE MENTAL HEALTH CENTER
111 S. TREATY ROAD
MIAMI OK 74354

Address last updated on 4/1/2024
Phone #: (918) 540-1511
Fax #: (918) 540-7374
County: OTTAWA
License: 1732
Dated: 4/23/2008
Expires: 3/31/2025
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:
GRAND LAKE MENTAL HEALTH CENTER
111 S. TREATY ROAD
MIAMI OK 74354

Phone #: (918) 540-1511
Fax #: (918) 540-7374

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
PAUL KONRAD FUHRMEISTER MD 23275
WELDON JOHN MALLGREN DO 2466
DAVID L. MCELWAIN MD 14829

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