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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, April 24, 2024 12:02 PM CDT
Next Update: Wednesday, April 24, 2024 4:30 PM CDT

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WALLACE, JERALD KENDELL
Practice Address: RR 1
FARRIS OK 74542
Phone #:
Fax #:
County: ATOKA
License: 420
Dated: 10/1/1983
Expires: 3/31/1987
License Type: Physician Assistant
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year:
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:
RR 1
FARRIS OK 74542

Phone #:
Fax #:

Hospital Privileges:

None listed

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