COSTELLO, BRIAN LEE - Licensee Information

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COSTELLO, BRIAN LEE

Practice Address:	VANCE AIR FORCE BASE PRIMARY CARE CLINIC 527 GOTH ROAD VANCE AFB OK 73705
Phone #:
Fax #:
County:	GARFIELD
License:	723
Dated:	5/13/1995
Expires:	3/31/1997
Temp. Ltr. Issued:	5/1/1995
Temp. Ltr. Expires:	7/15/1995
License Type:	Physician Assistant
Specialty:

Status:	Inactive
Status Class:	Expired License
Restricted to:
CME Year:	1997

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:
VANCE AIR FORCE BASE PRIMARY CARE CLINIC 527 GOTH ROAD VANCE AFB OK 73705 Phone #: 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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