CUSTIS, DAVID KENNETH - Licensee Information

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CUSTIS, DAVID KENNETH

Practice Address:	BLUE STEM CLINIC 224 S E DEBELL AVENUE BARTLESVILLE OK 74006
Phone #:
Fax #:
County:	WASHINGTON
License:	773
Dated:	6/17/1996
Expires:	3/31/1999
Temp. Ltr. Issued:	4/18/1996
Temp. Ltr. Expires:	7/27/1996
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:
BLUE STEM CLINIC 224 S E DEBELL AVENUE BARTLESVILLE OK 74006 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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