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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Monday, April 22, 2024 6:57 PM CDT
Next Update: Tuesday, April 23, 2024 2:50 AM CDT

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THENMADATHIL, MERRY MATHEW
Practice Address: PEDIATRIC ENT OF OKLAHOMA
9900 BROADWAY EXT
STE 200
OKLAHOMA CITY OK 73114

Address last updated on 3/7/2024
Phone #: (405) 608-8833
Fax #: (405) 608-8188
County: OKLAHOMA
License: 1857
Dated: 1/14/2010
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:
PEDIATRIC ENT OF OKLAHOMA
9900 BROADWAY EXT
STE 200
OKLAHOMA CITY OK 73114

Phone #: (405) 608-8833
Fax #: (405) 608-8188

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
GERMAN PAUL DIGOY MD 24270
ROBERT SCOTT GLADE MD 26967
JOHN ROLAND HOUCK MD 17455
JESUS EDILBERTO MEDINA MD 14989
JOSE ANTONIO SANCLEMENT MD 25575
Margo Rose Tanghetti DO 6262
NILESH RAMAN VASAN MD 23030
IVAN WAYNE MD 22995
ELENA BETH WOODSON MD 31155

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