Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 1
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts TulsaTulsa, OK74132-1823
[email protected] Excl. Body Parts/Svcs:Contact: Jan NonePhone: (918) 513-3226 Fax: (918) 447-9308
American Board of AnesthesiologyT
Anesthesiology Emad Attallah-Wasif, M.D. 2811 E 15th Street Suite 102 pain management TulsaTulsa, OK74104
Contact: ChristinaPhone: (918) 935-3240 Fax: ( ) -
American Board of AnesthesiologyT
Anesthesiology Blake Christensen, D.O. 14100 Parkway Commons Dr Suite 100 All, intervential pain management Oklahoma CityOklahoma City, OK73134
Excl. Body Parts/Svcs:Contact: Jeniffer Heart, Kidneys, Liver, Lungs, GIPhone: (405) 286-9820 Fax: ( ) -
Certification UnknownT R MITF
Anesthesiology David P. Ellis, M.D. 701 NE 10 Street pain management/interventional pain Oklahoma Citymedicine/spinal cord stimulatorsOklahoma City, OK73104
[email protected]. Body Parts/Svcs:Contact: BettyheadachePhone: (405) 232-8003 Fax: (405) 232-8008
American Board of Anesthesiology -Pain Medicine
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 2
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Frank J. Hackl, M.D. 9709 E 79th Street South Pain Management TulsaTulsa, OK74133
Contact: AngiePhone: (918) 994-4068 Fax: (918) 994-4095
American Board of Anesthesiology -Pain Medicine
T
Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: Brenda all except pain management casesPhone: (918) 477-5943 Fax: ( ) -
American Osteopathic Board ofAnesthesiology & Pain Management
T
Anesthesiology Daniel G. Morris, D.O.* 4110 S 100th East Ave Suite 201 Pain Management Only TulsaTulsa, OK74146
[email protected]: schedulingPhone: (918) 857-7246 Fax: (918) 359-5828
American Osteopathic Board ofAnesthesiology-Pain Management
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 3
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology John W. Nelson, M.D. 3535 NW 58 Street Ste 950E all pain management Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Stephanie nonePhone: (405) 702-8623 Fax: (405) 702-8628
American Board ofAnesthesiology/Internal Med.
T
Anesthesiology Michael Chad Owens, D.O. 427 E Cherokee Interventional Pain Management Enid(total body)Enid, OK73701
[email protected]. Body Parts/Svcs:Contact: BarbaranonePhone: (580) 234-7246 Fax: ( ) -
American Board of AnesthesiologyT
Anesthesiology Jayen H. Patel, M.D. 2811 E 15 Street Ste 102 pain management, neck, back, Tulsaextremities, nervous system,Tulsa, OK 7410-4headache, joints, [email protected]
Contact: appt deskExcl. Body Parts/Svcs:Phone: (918) 935-3240 Fax: (918) 935-3241PTSD, psychological trauma
American Board of AnesthesiologyT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 4
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Terrell R. Phillips, D.O. 401 SW 80 Street Ste 200 Pain Management Oklahoma CityOklahoma City, OK73139
[email protected] Excl. Body Parts/Svcs:Contact: Tammy none within specialtyPhone: (405) 601-4227 Fax: (405) 601-4237
American Osteopathic Board ofAnesthesiology
T R MITF
Anesthesiology Justin Porter, M.D. 3601 NW 138 Street Ste 200 Pain Management - head, neck,back Oklahoma CityOklahoma City, OK73134
[email protected] Excl. Body Parts/Svcs:Contact: Neile pelvic pain, vaginal pain, rectal
painPhone: (405) 242-4100 Fax: (405) 775-9356
Certification UnknownT
Anesthesiology Andreas "Andrew" Revelis, M.D. 2000 S Wheeling Ave Ste 600 pain management TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Pat NonePhone: (918) 742-7030 Fax: (918) 742-9958
Certification UnknownT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 5
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Hugo S. Salguero, M.D. 9320 South Mingo Road Anesthesia/pain management TulsaTulsa, OK74133
asalguero@advanced paintulsa.com Excl. Body Parts/Svcs:Contact: scheduling nonePhone: (918) 879-1700 Fax: (918) 879-1701
Am Board of Anesthesiology - PainManagement
T
Anesthesiology Adam J. Wallace, M.D. 6802 S Olympia Ave Ste 100 pain management TulsaTulsa, OK74132
[email protected] Excl. Body Parts/Svcs:Contact: Angelia, Julie nonePhone: (918) 447-9300 Fax: (918) 447-9308
Certification UnknownT
Anesthesiology Kalvin L. White, D.O. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK74132-1823
[email protected]: AngeliaPhone: (918) 513-3231 Fax: (918) 447-9308
Am Board of AnesiologyT
Anesthesiology Traci L. White, M.D. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK73132-1923
Contact: BuffyPhone: (918) 513-3225 Fax: (918) 447-9308
American Board ofAnesthesiology/Pain Medicine
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 6
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Michael A. Chiaffitelli, D.C. 10001 S Penn Bldg P Ste 170 all chiropractics - spine Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Alisha all but spinePhone: (405) 681-2273 Fax: (405) 681-2274
Certification UnknownT R
Chiropractic Seyoung Kim, D.C. 5583 NW Expressway spine (neck, back), hand Oklahoma CityOklahoma City, OK73132
Excl. Body Parts/Svcs:Contact: Jennifer NonePhone: (405) 773-3131 Fax: (405) 773-4267
Certification UnknownT
Chiropractic Hugh G. McClure, D.C. 401 Vandament Ave Ste 102 whole body YukonYukon, OK73099
[email protected] Excl. Body Parts/Svcs:Contact: Amy NonePhone: (405) 350-7283 Fax: (405) 354-7802
Certification Unknown R MITF
Chiropractic C. Keith Muse, D.C. 6825 S Western Ave neuromusculoskeletal Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Peggy NonePhone: (405) 634-1127 Fax: (405) 634-1177
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 7
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Jim R. Muse, D.C. 6825 S Western Full Body Oklahoma CityOklahoma City, OK73139
Contact: Ann, PeggyPhone: (405) 634-1127 Fax: (405) 634-1177
Certification UnknownT R MITF
Chiropractic James Daniel Post, D.C. 4141 NW Expressway Ste 180 all chiropractics-spine Oklahoma CityOklahoma City, OK73116
[email protected]: Rhonda, CathyPhone: (405) 840-8900 Fax: (405) 840-8990
Certification UnknownT
Chiropractic Keith G. Ryan, D.C. 3319 E 46 St Ste 101 back and extremities TulsaTulsa, OK74135-2903
[email protected] Excl. Body Parts/Svcs:Contact: Dr. Ryan NonePhone: (918) 742-6262 Fax: (918) 742-7152
Certification UnknownT R
Chiropractic Troy A. Sturgill, D.C. PO Box 335 musculoskeletal WoodwardWoodward, OK73802
Excl. Body Parts/Svcs:Contact: self brain, heart, lungs, visionPhone: (580) 256-1555 Fax: (580) 256-3370
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 8
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Steve Sweeney, D.C. 211 S. Sooner Rd. Spine, upper and lower extremities Midwest CityMidwest City, OK73110
[email protected] Excl. Body Parts/Svcs:Contact: Misty Cardiovascular, Pulmonary,
Digestive HematopoieticPhone: (405) 672-4800 Fax: ( ) -
Certification UnknownT R
Chiropractic Ronald B. Tripp, D.C. 2400 Tee Circle neck and back NormanNorman, OK73069
[email protected] Excl. Body Parts/Svcs:Contact: Sherri internal medicinePhone: (405) 321-8530 Fax: (405) 321-1478
Certification UnknownT R MITF
Chiropractic David B. Waggoner, D.C. 7000 NW Expressway Ste H chiropractic Oklahoma CityOklahoma City, OK73132
[email protected] Excl. Body Parts/Svcs:Contact: Meaghan non-musculoskeletalPhone: (405) 773-1113 Fax: ( ) -
Certification UnknownT
Dentistry Melvin Burnitt Baker, Jr., D.D.S. 7405 NW 23 St general dentistry BethanyBethany, OK73008
[email protected] Excl. Body Parts/Svcs:Contact: Stacey NonePhone: (405) 787-5266 Fax: (405) 495-5060
Certification Unknown
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 9
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Dentistry Larry S. Baker, D.D.S. 2616 W I-44 Service Rd mouth: teeth, temporomandibular Oklahoma CityjointsOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Maryanything not dentally relatedPhone: (405) 943-3575 Fax: ( ) -
Certification UnknownT R MITF
Dentistry Steven W. Hogg, D.D.S. 423 W Washington St mouth, teeth Broken ArrowBroken Arrow, OK74012
[email protected] Excl. Body Parts/Svcs:Contact: Mary NonePhone: (918) 455-8899 Fax: (918) 362-9997
Certification UnknownT R MITF
Dentistry Sterling H. Stalder, D.D.S 930 SW 107 Street mouth and teeth Oklahoma CityOklahoma City, OK73170
[email protected] Excl. Body Parts/Svcs:Contact: Renee/ Jenae nonePhone: (405) 634-7303 Fax: (405) 634-7868
Certification UnknownT
Family Medicine Thomas Carlile, D.O. 3916 S Sunnylane Road all body parts Del CityDel City, OK73115
Excl. Body Parts/Svcs:Contact: Lisa eyesPhone: (405) 677-3378 Fax: ( ) -
American College Osteopathic FamilyPhysicians
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 10
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine YinYin J L Devoe, M.D. 9320 South Mingo Road Medication Management TulsaTulsa, OK74133
[email protected] Excl. Body Parts/Svcs:Contact: scheduling elbow, knee, wristPhone: (918) 879-1704 Fax: (918) 879-1714
American Board of Family MedicineT
Family Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 Musculoskelital system and all body Oklahoma CityorgansOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: KellyeyesPhone: (405) 917-5336 Fax: (405) 917-2250
American Board of Family MedicineT R MITF
Family Medicine Val Joseph Fiorazo, M.D.* 4330 SE 29 St Ste 3018 back, neck, upper, lower Oklahoma CityextremitiesDel City, OK73115
[email protected]. Body Parts/Svcs:Contact: Dr. Fiorazolungs, heart, brain, skin, hearingPhone: (405) 670-8100 Fax: (405) 670-8558
American Board of Family PracticeT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 11
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine Gary Robert Lee, M.D.* 5577 South Lewis Ave all TulsaTulsa, OK74105
[email protected] Excl. Body Parts/Svcs:Contact: Gail NonePhone: (918) 749-0003 Fax: ( ) -
American Board of Family Medicine -Sports Medicine
T R MITF
Family Medicine Jason M. Leinen, M.D.* 3115 SW 89 Street all family & sports medicine, pain Oklahoma CitymanagementOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: AmynonePhone: (405) 600-1411 Fax: (405) 600-1531
American Board of Family MedicineT R
Family Medicine Seethal Madhavarapu, M.D. 3400 W Tecumseh Suite 101 knees, shoulders, neck, back, Norman, Moore,elbow, hand, ankle, foot EdmondNorman, OK73072Excl. Body Parts/Svcs:Contact: BrookepelvisPhone: (405) 360-6764 Fax: ( ) -
American Board of Family MedicineT R
Family Medicine Michael L. Winzenread, M.D. 105 S Bryant Ste 310 all EdmondEdmond, OK73034
Excl. Body Parts/Svcs:Contact: Kari NonePhone: (405) 757-5211 Fax: ( ) -
American Board of Family Practice R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 12
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Practice Gary Robert Lee, M.D.* 5577 South Lewis Ave all TulsaTulsa, OK74105
[email protected] Excl. Body Parts/Svcs:Contact: Gail NonePhone: (918) 749-0003 Fax: ( ) -
American Board of Family Medicine -Sports Medicine
T R MITF
Family Practice Timothy L. Moore, D.O. 3212 SW 89 Street Ste 100 pain management, whole body Oklahoma CityOklahoma City, OK73159
[email protected] Excl. Body Parts/Svcs:Contact: Rhoda/Alicia psychiatric casesPhone: (405) 378-3300 Fax: (405) 378-3993
Certification UnknownT
Family Practice Daniel G. Morris, D.O.* 4110 S 100th East Ave Suite 201 Pain Management Only TulsaTulsa, OK74146
[email protected]: schedulingPhone: (918) 857-7246 Fax: (918) 359-5828
American Osteopathic Board ofAnesthesiology-Pain Management
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 13
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Practice Lance E. Rosson, D.O. 1211 N Shartel Ste 1104 all Oklahoma CityOklahoma City, OK73103
NONE Excl. Body Parts/Svcs:Contact: Sharon NonePhone: (405) 236-1900 Fax: (405) 236-0362
American Board of Family PhysiciansT R MITF
General Surgery Joshua Carey, M.D. 1700 S Renaissance Blvd within speciality EdmondEdmond, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: scheduling hands, feetPhone: (405) 844-4300 Fax: ( ) -
American Board of SurgeryT
General Surgery Russell L. Hanan, Jr., M.D. 608 NW 9 Ste 5010 general surgery hernias, Oklahoma Cityintestines, soft tissueOklahoma City, OK73102
noneExcl. Body Parts/Svcs:Contact: Debbie Smithhead, neck, spine, pulmonaryPhone: (405) 235-3245 Fax: (405) 235-6991
Certification UnknownT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 14
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists
American Board of Plastic Surgery &Am Bd Plastic Surg of Hand
T R MITF
Hand Surgery James F. Bischoff, M.D.* 6475 S Yale Ave Ste 301 hands, wrists TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: CJ spine, elbows, shoulders, feet,
ankles, knees, hips, rate onlyPhone: ( ) - Fax: (918) 494-9397cases
American Board of OrthopedicSurgery
T R
Hand Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 upper extremities (shoulder down to Tulsafingers)Tulsa, OK74104
[email protected]. Body Parts/Svcs:Contact: Raeknees, back, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293
American Osteopathic Board ofOrthopedic Surgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 15
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Michael B. Clendenin, M.D. 2000 S Wheeling Ste 900 hands and wrists only TulsaTulsa, OK74104
NONE Excl. Body Parts/Svcs:Contact: Sheila all except hands and wristsPhone: (918) 749-1418 Fax: (918) 749-6241
American Board of OrthopedicSurgery
T R
Hand Surgery Tom W. Ewing, D.O. 1020 24 Ave NW Ste 100 hands NormanNorman, OK73069
[email protected] Excl. Body Parts/Svcs:Contact: Melissa or Dana all except handsPhone: (405) 447-4999 Fax: (405) 447-5608
American Osteopathic Board ofOrthopedic Surgery
T R
Hand Surgery Joel L. Frazier, M.D.* 1044 SW 44 St Ste 600 hands, upper extremities, elbows, Oklahoma CitywristsOklahoma City, OK73109
[email protected]. Body Parts/Svcs:Contact: eRNESTall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 16
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Charles H. Funderburk, M.D.* 1110 N Lee hands, shoulders, elbows, knees, Edmond,wrists, forearm Oklahoma CtiyOklahoma City, OK73103-2612
[email protected]. Body Parts/Svcs:Contact: neck, back, hips, feetPhone: (405) 230-9743 Fax: (405) 522-9474
American Board of OrthopedicSurgery
T R
Hand Surgery Greg Halko, M.D.* 3301 NW 50 hands, upper extremities Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) and lower
extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043
American Board of OrthopedicSurgery
T R MITF
Hand Surgery Daron C. Hitt, M.D. 3115 SW 89 Street hands only Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 424-5630 Fax: (405) 692-1632
American Board of SurgeryT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 17
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Thomas C. Howard, M.D.* 1110 N Lee hands, shoulders, knees, hips and Oklahoma City,feet NormanOklahoma City, OK73103-2612
[email protected]. Body Parts/Svcs:Contact: schedulingspine, (neck,back)Phone: (405) 230-9752 Fax: (405) 230-9424
American Board of OrthopedicSurgery
T R
Hand Surgery Stephen W. Mihalsky, M.D. 105 S Bryant Ste 407 all within specialty Midwest City,EdmondEdmond, OK73034
Excl. Body Parts/Svcs:Contact: Donna Elswick shoulders, neckPhone: (405) 348-5060 Fax: (405) 364-8750
American Board of Surgery of theHand, American Board of Surgery
T R
Hand Surgery David B. Mokhtee, M.D. 4802 S. 109th E. Ave. fingers to elbows TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya all expcept handsPhone: (918) 392-1400 Fax: (918) 392-1401
American Board of Surgery - HandSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 18
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery M. Sean O'Brien, D.O.* PO Box 890358 hands and shoulders Oklahoma CityOklahoma City, OK73189
Excl. Body Parts/Svcs:Contact: Marilyn back, neck, feetPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
Hand Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand Oklahoma CityOklahoma City, OK73112-4418
Excl. Body Parts/Svcs:Contact: backPhone: (405) 945-4888 Fax: (405) 945-4887
American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand
T R MITF
Hand Surgery Richard A. Ruffin, M.D.* 3301 NW 50 hands, wrists, elbows, shoulders Oklahoma CityOklahoma City, OK73112-5691
Excl. Body Parts/Svcs:Contact: Central Scheduling neck & back (spine), feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263
American Board of OrthopedicSurgery, Hand Surgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 19
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Houshang Seradge, M.D.* 1044 SW 44 Street Suite 518 spine, foot, wrist, elbow, Oklahoma Cityshoulder, hip, knee, ankleOklahoma City, OK73109
Contact: MistiPhone: (405) 634-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R MITF
Hand Surgery Garrett Watts, M.D. 10507 E 91st Street Suite 350 hands, wrists, elbows Broken ArrowTulsa, OK74133
[email protected] Excl. Body Parts/Svcs:Contact: Central States Orthopedic spine, neck, lower extremitiesPhone: (918) 451-3000 Fax: (918) 451-2700
American Board of OrthopedicSurgery
T R MITF
Internal Medicine S.A. Chaudry, M.D. 5611 Mosteller Dr all internal medicine - whole body Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Cheryl NonePhone: (405) 843-2345 Fax: (405) 843-8237
American Board of Internal MedicineT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 20
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Internal Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131
NONE Excl. Body Parts/Svcs:Contact: Yvonne, Leslie psychiatricPhone: (405) 840-6720 Fax: (405) 840-6723
American Board of Internal Medicine R MITF
Internal Medicine A. E. Moorad, M.D.* 4221 S Western Ste 3010 all PM & R, pain managment Oklahoma CityOklahoma City, OK73109
Contact: MarilynPhone: (405) 636-7450 Fax: (405) 631-2296
American Board of Internal MedicineT R MITF
Internal Medicine Venkatesh Movva, M.D.* 6565 S Yale Ste 212 pain management TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Michelle migrainesPhone: (918) 502-4008 Fax: (918) 502-4001
American Board of Internal MedicineT
Internal Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda LungsPhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 21
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurology Ellen E. Hope, M.D. 14100 Parkway Comons Dr Ste 102 head, neck, spine, brain Oklahoma CityOklahoma City, OK73134
[email protected] Excl. Body Parts/Svcs:Contact: Christine or Bliss all those not listedPhone: (405) 270-0500 Fax: (405) 270-0597
American Board of Psychiatry andNeurology
T
Neurology Gabriel Pitman, D.O. 401 SW 80 STE 201 all within neurology specialty Oklahoma CityOklahoma City, OK73139
[email protected] Excl. Body Parts/Svcs:Contact: Paula Byrd abdomen, chestPhone: (405) 632-9090 Fax: ( ) -
American Board of NeurologyT
Neurology W. Dean Shipley, M.D. 4120 W Memorial Rd Ste 218 nervous system only/adult nerology Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Kelly neuological IME's onlyPhone: (405) 302-2661 Fax: (405) 302-2670
American Board of Psychiatry andNeurology
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 22
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neuropsychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126
Contact: GaryPhone: (405) 271-8001 Fax: (405) 271-8802
American Board of ProfessionalPsychology/Clinical Neuropsych
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Neuropsychology - Clinical Michael R. Basso, Ph.D.* Univ of Tulsa Dept of Psychology head/brain - diatnostic testing, Tulsapsychological overlay800 S Tucker Drive
[email protected] Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Dr. BassoNonePhone: (918) 631-3151 Fax: (918) 631-2833
ABPP - Clinical Neuropsychology R MITF
Neuropsychology Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehabilitation (nervous system, Tulsawhole body) Trauma RelatedTulsa, OK74136Disorders (pain stress, depression,brain)Contact: Suzan
Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 23
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neuropsychology Douglas O. Brady, Ph.D.* 1401 SW Park Ridge Blvd Ste D medical psychology, neuropsychology LawtonevaluationsLawton, OK73505
[email protected]: D'AnnPhone: (580) 355-7474 Fax: (580) 355-6765
American Board of ProfessionalDisability
T R MITF
Neuropsychology David E. Hansen, Ph.D. 5512 S Lewis Ave Ste 8 neuropsychology/brain TulsaTulsa, OK74105
[email protected] Excl. Body Parts/Svcs:Contact: Emge NonePhone: (918) 712-9004 Fax: (918) 712-9120
Certification Unknown R MITF
Neuropsychology Terry G. Shaw, Ph.D. 7146 S Braden Ste 500 head, brain, psychological overlay TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Mary all excluded except parts listed as
specialtyPhone: (918) 488-6165 Fax: (918) 488-8021
American Board of ProfessionalNeuropsychology
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* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 24
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neuropsychology Adam G. Sherman, Ph.D. 3015 E Skelly Dr Ste 135 all within specialty TulsaTulsa, OK74105
Excl. Body Parts/Svcs:Contact: Susan NonePhone: (918) 712-2885 Fax: (918) 712-9019
Certification UnknownT R
Neurosurgery Clinton J. Baird, M.D. 6802 S Olympia Ave Ste 350 spine, brain, nerves, carpal Tulsatunnel, ulnar nerve, neurosurgeryTulsa, OK74132
[email protected]. Body Parts/Svcs:Contact: Sheilahips, knees, jointsPhone: (918) 749-0762 Fax: (918) 744-4246
Certification UnknownT R
Neurosurgery Daniel Boedeker, M.D. 6767 S Yale Ave Ste A brain, spine, peripheral nerve for Tulsacarpal tunnelTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: Kimall except specialtyPhone: (918) 491-3521 Fax: (918) 491-3542
Certification UnknownT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 25
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Christopher G. Covington, M.D. Attn: Sheila Harless spine, brain, carpel tunnel Tulsa6802 S Olympia Ave Ste 300
[email protected] Tulsa, OK74132 Excl. Body Parts/Svcs:Contact: Sheila, Jamie extremitiesPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
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Neurosurgery Allan S. Fielding, M.D. 2000 S Wheeling Ste 1110 head, neck, back, shoulder, hip, Tulsaknee, CTS, ulnar neuropathyTulsa, OK74104
[email protected]. Body Parts/Svcs:Contact: any staff memberNeurosurgical Cases OnlyPhone: (918) 294-0080 Fax: ( ) -
American Board of NeurologicalSurgery
T R MITF
Neurosurgery Emily D. Friedman, M.D. 3435 NW 56 Bldg A Ste 210 brain, spine, neck Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Dana all body parts not specifiedPhone: (405) 945-4902 Fax: (405) 945-4901
American Board of NeurologicalSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 26
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Eric S. Friedman, M.D. 4120 W Memorial Rd Ste 300 brain and carpal tunnel only Oklahoma CityOklahoma City, OK73120-9322
[email protected] Excl. Body Parts/Svcs:Contact: Kelsey spine, shoulders, knees, lower
extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
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Neurosurgery Steven E. Gaede, M.D. 6802 S Olympia Ave Ste 300 spine, brain, carpal tunnel, ulnar TulsanerveTulsa, OK74132
[email protected]. Body Parts/Svcs:Contact: Sheila,Susienon-spine orthopedic casesPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
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Neurosurgery Michael Hahn, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), hands (carpal Oklahoma Citytunnel)Oklahoma City, OK73120
[email protected]. Body Parts/Svcs:Contact: Tammyshoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 27
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Brent N. Hisey, M.D. 14100 Parkway Commons Dr Ste 201 spine (neck, back), brain, carpal Oklahoma CitytunnelOklahoma City, OK73134
[email protected]. Body Parts/Svcs:Contact: Alishaall except specialtyPhone: (405) 242-4720 Fax: (405) 242-4933
American Board of NeurologicalSurgery
T R MITF
Neurosurgery Donald D. Horton, M.D. 14100 Parkway Commons Dr Ste 201 spinal surgery (cervical/lumbar) Oklahoma Citycarpal tunnelOklahoma City, OK73134
[email protected]. Body Parts/Svcs:Contact: Marie, Alishaall except cervical, lumbar, carpalPhone: (405) 242-4720 Fax: (405) 242-4765tunnel
American Board of NeurologicalSurgery
T R MITF
Neurosurgery Douglas Koontz, M.D. 6767 S Yale Ste A brain, spine (thoracic, cervical, Tulsalumbar), carpal tunnelTulsa, OK74136
noneContact: JaclynPhone: (918) 491-3521 Fax: ( ) -
American Board of NeurologicalSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 28
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Kyle Mangels, M.D. 6802 S Olympia Ave Ste 300 neurological surgery spine, brain, Tulsacarpal tunnel. ulnar nerveTulsa, OK74132
[email protected]. Body Parts/Svcs:Contact: Sheila, Jamiehips, knees, jointsPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
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Neurosurgery John S. Marouk, D.O. 2128 S Atlanta PL Ste 100 spine, brain only TulsaTulsa, OK74114
[email protected] Excl. Body Parts/Svcs:Contact: all other body partsPhone: (918) 583-5131 Fax: (918) 592-0670
American Osteopathic Board ofSurgery
T R MITF
Neurosurgery Fadi F Nasr, M.D. 4120 W Memorial Rd, Ste 300 Spine (neck, back), hands (carpal Oklahoma Citytunnel)Oklahoma City, OK73120
[email protected]. Body Parts/Svcs:Contact: Stephanieshoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: ( ) -
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 29
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Stan Pelofsky, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Angie shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-2920
American Board of NeurologicalSurgery
T
Neurosurgery Ryan F. Rahhal, M.D. 6767 S Yale Ave Ste A brain, spine (thoracic, lumbar, & Tulsacervical), carpal tunnelTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: Kim Perry, Jacci Carpioall ot neurosurgicalPhone: (918) 492-7587 Fax: (918) 492-4033
Certification UnknownT R
Neurosurgery Robert L. Remondino, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists (carpal tunnel) Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Linda shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 30
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery W. Emery Reynolds, M.D. 4120 W Memorial Ste 208 head, spine Oklahoma CityOklahoma City, OK73120
NONEContact: SondraPhone: (405) 755-3540 Fax: (405) 755-7001
American Board of NeurologicalSurgery
T
Neurosurgery James A. Rodgers, M.D. 6565 S Yale Ste 709 cervical & lumbar spine carpal TulsatunnelTulsa, OK74136
Contact: RitaPhone: (918) 481-4965 Fax: (918) 481-4996
American Board of NeurologicalSurgery
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Neurosurgery Eric W. Sherburn, M.D. 6802 S Olympia Ave Ste 300 brain, spine (neck, back), carpal Tulsatunnel, ulnar nerveTulsa, OK74132
[email protected]. Body Parts/Svcs:Contact: Sheila, Susieorthopedic casesPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 31
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Brian E. Snell, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), hands (carpal Oklahoma Citytunnel)Oklahoma City, OK73120
[email protected]. Body Parts/Svcs:Contact: CALLIEshoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
Neurosurgery Caple A Spence, M.D. 8121 National Ave Ste 210 brain, spine, peripheral nerves MWCMidwest City, OK73110
[email protected] Excl. Body Parts/Svcs:Contact: Christy all except brain, spine, peripheral
nervesPhone: (405) 455-3393 Fax: (405) 455-7162
American Board of NeurologicalSurgery
T
Neurosurgery Nathaniel Stetson, D.O. neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Marlea Shouldler, knee, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671
Certification UnknownT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 32
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Qualls Stevens, D.O. 8 SW 89 Street Suite 100 brain, spine, carpal tunnel, ulnar OKCnerveOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: schedulingall outside specialtyPhone: (405) 455-3322 Fax: (405) 606-4668
Am Osteopathic Board ofNeurological Surgery
T
Neurosurgery Robert E. Tibbs, M.D. 4120 W Memorial Rd Ste 300 TREATMENT AUTHORIZATION for neck,Oklahoma Cityback, wrists (carpal tunnel)Oklahoma City, OK73120
[email protected]. Body Parts/Svcs:Contact: Angieshoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-1671
American Board of NeurologicalSurgery
T
Neurosurgery Frank J. Tomecek, M.D. 6802 S Olympia Ave Ste 300 spine (neck, back), brain, carpal Tulsatunnel, ulner nerveTulsa, OK74132
[email protected] & [email protected]. Body Parts/Svcs:Contact: Sheila, Susielegs, hipsPhone: (918) 749-0762 Fax: (918) 749-8531
American Board of NeurologicalSurgery
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* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 33
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Benjamin T. White, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Kelsey shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-1671
American Board of NeurologicalSurgery
T
Neurosurgery Robert J. Wienecke, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists{carpal tunnel) Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Marlea shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-1671
American Board of NeurologicalSurgery
T
Neurosurgery Gregory L. Wilson, D.O. 9709 E 79 Street South brain, neck, back TulsaTulsa, OK74133
[email protected]: PamPhone: (918) 994-4068 Fax: (918) 994-4095
Am Board of OsteopathicNeurological Surgery
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* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 34
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 Musculoskelital system and all body Oklahoma CityorgansOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: KellyeyesPhone: (405) 917-5336 Fax: (405) 917-2250
American Board of Family MedicineT R MITF
Occupational Medicine Val Joseph Fiorazo, M.D.* 4330 SE 29 St Ste 3018 back, neck, upper, lower Oklahoma CityextremitiesDel City, OK73115
[email protected]. Body Parts/Svcs:Contact: Dr. Fiorazolungs, heart, brain, skin, hearingPhone: (405) 670-8100 Fax: (405) 670-8558
American Board of Family PracticeT R MITF
Occupational Medicine William R. Gillock, M.D. 7170 S Braden Ste 175 all body parts TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Sharon nonePhone: (918) 481-0994 Fax: (918) 494-6747
American Board of Internal Medicine& Preventive Medicine
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 35
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine John W. Hallford, D.O. 5682 W Skelly Dr occupational medicine/urgent care TulsaTulsa, OK74107
[email protected] Excl. Body Parts/Svcs:Contact: Julie nonePhone: (918) 446-1891 Fax: (918) 446-1894
American Osteopathic Board ofFamily Physicians
T R MITF
Occupational Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131
NONE Excl. Body Parts/Svcs:Contact: Yvonne, Leslie psychiatricPhone: (405) 840-6720 Fax: (405) 840-6723
American Board of Internal Medicine R MITF
Occupational Medicine Andrew C. John, M.D. 4323 NW 63 Street Ste 105 all occupational medicine Oklahoma CityOklahoma City, OK73116
[email protected] Excl. Body Parts/Svcs:Contact: Jerri Psychological/PsychiatricPhone: (405) 843-0610 Fax: (405) 843-0620
Certification Unknown R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 36
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine William D. Jones, M.D. 707 NW 13 St all occupational medicine (rating Oklahoma Cityonly)Oklahoma City, OK73103
[email protected]. Body Parts/Svcs:Contact: Jeannefemale reproductive systemPhone: (405) 521-8604 Fax: (405) 521-8605
Certification Unknown R MITF
Occupational Medicine John A. Munneke, M.D. 36 W Memorial Ste B9 all including occupational Oklahoma City,medicine, MITF, Form 3, pain TulsaOklahoma City, [email protected]
Contact: JoAnne, KerriExcl. Body Parts/Svcs:Phone: (405) 755-9702 Fax: (405) 755-9718eyes
Certification UnknownT R MITF
Occupational Medicine Robert Paul, M.D. 6717 S Yale Ave Suite 107 all within specialty TulsaTulsa, OK74136
Contact: LindaPhone: (918) 496-1991 Fax: ( ) -
Certification Unknown R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 37
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine Carl B. Pettigrew, D.O. 1211 N Shartel Ste 500 all Oklahoma City,TulsaOklahoma City, OK73103
[email protected] Excl. Body Parts/Svcs:Contact: Karen NonePhone: (405) 239-7766 Fax: (405) 235-4895
Certification UnknownT R MITF
Occupational Medicine J. A. Snelling, D.O. PO Box 702738 Occupational Medicine TulsaMusculoskeletal/SkinTulsa, OK74170
noneExcl. Body Parts/Svcs:Contact: selfcardiovascular, eyesPhone: (918) 749-3187 Fax: (918) 491-9925
American Board of FamilyPhysicians, Am Board of PreventiveMed.
R
Occupational Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda LungsPhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 38
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical Tulsa, OKCmaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-TayllerNonePhone: (918) 488-8285 Fax: (405) 949-1801
Certification UnknownT R MITF
Ophthalmology John P. Belardo, M.D. 11308 N Penn eyes only Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Patti all except eyesPhone: (405) 755-7700 Fax: (405) 755-7739
American Board of OphthalmologyT R MITF
Orthopedic Surgery Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 39
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery John W. Anderson, M.D. 3301 NW 50 St foot and ankle Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck, back) and upper
extremitiesPhone: (405) 947-0911 Fax: (405) 948-5177
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Kristopher R. Avant, D.O. 8100 S Walker Ave Bldg A upper extremities, hands, wrists, OKCelbows, knees, shouldersOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: Beckyback, neckPhone: (405) 632-4468 Fax: ( ) -
Certification UnknownT R MITF
Orthopedic Surgery John Charles Balbas, M.D. 4802 S 109 E Ave all except back, neck, hands TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: ( ) -
American Board of OrthopaedicSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 40
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566
[email protected] Excl. Body Parts/Svcs:Contact: Pam back, neckPhone: (918) 994-4068 Fax: (918) 994-4095
Certification UnknownT R
Orthopedic Surgery Jaafar M. Bazih, M.D. 4802 S 109 E Ave extremities, hands TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Denise spine: back & neckPhone: (918) 392-1400 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Jack Beller, M.D. all orthopedics Oklahoma City,
[email protected]: Central schedulingPhone: ( ) - Fax: ( ) -
American Board of OrthopaedicSergery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 41
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery James F. Bischoff, M.D.* 6475 S Yale Ave Ste 301 hands, wrists TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: CJ spine, elbows, shoulders, feet,
ankles, knees, hips, rate onlyPhone: ( ) - Fax: (918) 494-9397cases
American Board of OrthopedicSurgery
T R
Orthopedic Surgery David Bobb, M.D. 825 E Robinson all except back & head NormanNorman, OK73071
[email protected] Excl. Body Parts/Svcs:Contact: Donna back & headPhone: (405) 364-8855 Fax: ( ) -
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery James Lee Bond, M.D. 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Norman,ankle Oklahoma CityNorman, OK73072
[email protected]. Body Parts/Svcs:Contact: BROOKEall but listed body partsPhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 42
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: CJ spine, hips, feet, ankles, hands &
rate only casesPhone: (918) 494-9351 Fax: (918) 494-9397
American Board of OrthopedicSurgery/Sports Medicine
T R
Orthopedic Surgery R. Tyler Boone, M.D. 6475 S Yale Ave Ste 301 neck, back TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: Lori hands, hips, knees, feet, ankles
shoulders, elbows, no rate only casPhone: (918) 494-9384 Fax: (918) 494-9397
American Board of OrthopedicSurgery/AmBd Ortho Surg of theSpine
T R
Orthopedic Surgery Brett Braly, M.D. 1616 S. Kelly Ave Spine EdmondEdmond, OK73013
Excl. Body Parts/Svcs:Contact: Sondra all but SpinePhone: (405) 715-8842 Fax: ( ) -
Certification UnknownT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 43
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Steven P. Brantley, M.D. 3301 NW 50th Street knees and shoulders Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling Spine (neck and back)Phone: (405) 947-0911 Fax: ( ) -
Certification UnknownT
Orthopedic Surgery Christopher A. Browne, M.D. 6475 S Yale Ave Ste 301 hips, knees TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: Lori hands, spine, feet, ankles,
shoulders, elbows, no rate onlyPhone: (918) 494-9384 Fax: (918) 494-9397cases
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Mark A. Capehart, M.D. 6475 S Yale Ave Ste 301 neck, back, knees TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: Lori feet, hands, hips, ankles, elbows,
shoulders, no rate only casesPhone: (918) 494-9384 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 44
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery James D. Cash, M.D.* 6585 S Yale Ave Ste 200 knees, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: nonePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 upper extremities (shoulder down to Tulsafingers)Tulsa, OK74104
[email protected]. Body Parts/Svcs:Contact: Raeknees, back, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293
American Osteopathic Board ofOrthopedic Surgery
T R
Orthopedic Surgery Brian Clowers, M.D. 3400 W Tecumseh Ste 101 foot, ankle OKC, NormanNorman, OK73072
[email protected] Excl. Body Parts/Svcs:Contact: Brooke all except foot & anklePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 45
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Ashley Cogar, M.D. 6205 N Santa Fe Ste 200 elbow, wrist, hand Oklahoma CityOklahoma City, OK73118
[email protected] Excl. Body Parts/Svcs:Contact: Diana, Jennifer spine, shoulder, hip, knee, ankle
or footPhone: (405) 419-5665 Fax: (405) 541-9547
Certification UnknownT
Orthopedic Surgery Arthur Hobart Conley, III, M.D. 3110 SW 89 Ste 200E (spine) back and neck only Oklahoma CityOklahoma City, OK73159
[email protected] Excl. Body Parts/Svcs:Contact: Ronda all except spinePhone: (405) 703-7300 Fax: (405) 703-7333
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Jimmy Harold Conway, M.D. 10001 S Western Ste 101 elbows, knees Oklahoma CityOklahoma City, OK73139-2997
[email protected] Excl. Body Parts/Svcs:Contact: Nancy spine, feet, handsPhone: (405) 692-3700 Fax: (405) 692-3789
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 46
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Steven D. Coupens, M.D. 6205 N Santa Fe Ste 200 all body parts Oklahoma CityOklahoma City, OK73118
[email protected]: Phone: (405) 427-6776 Fax: (405) 419-5527
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Thomas G. Craven, M.D. 6585 S Yale Ste 200 spine (neck, back) TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Melissa, Linda hands, wrists, knees, anklesPhone: (918) 481-2767 Fax: (918) 481-7669
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Stephen R. Davenport, M.D. knee, hip, foot and ankle Oklahoma Cityreconstructive surgery, OK
[email protected]. Body Parts/Svcs:Contact: Central Schedulingspine, (neck, back), handsPhone: ( ) - Fax: ( ) -
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 47
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Scott De La Garza, M.D. 608 NW 9 Street Ste 6000 spine only (lumbar, cervical, Norman,thorasic) Oklahoma City,Oklahoma City, OK73102
[email protected]. Body Parts/Svcs:Contact: Brookeall except spinePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Kevin M. Dukes, M.D. 4802 S 109 E Ave shoulders TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Denise all but shoulderPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Ronald Matthew Dumigan, M.D. 1110 N Lee Knees, Shoulders, Elbows, ankles, Oklahoma City,Edmond, NormanOklahoma City, OK73103
[email protected] Excl. Body Parts/Svcs:Contact: Amy Spine, Neck, HipPhone: (405) 230-9405 Fax: (405) 230-9421
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 48
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Rory C. Dunham, D.O. 3110 SW 89th Suite 200C hand, knee, shoulder, ankle, elbow, Oklahoma Cityhip, feet, backOklahoma City, OK73159
[email protected]: MarilynPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery Scott J. Dunitz, M.D. 4802 S 109 E Ave hips, knees (adult reconstruction) TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Eugene G. Feild, M.D. 6600 S Yale Ste 1315 all within specialty TulsaTulsa, OK74136-3346
[email protected]: NancyPhone: (918) 481-7770 Fax: (918) 481-7797
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 49
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery David J. Flesher, M.D. 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck & back), feet, handsPhone: (405) 947-0911 Fax: (405) 948-5177
American Board of OrthopedicSurgery
T
Orthopedic Surgery Thomas H. Flesher, III, M.D. 3301 NW 50 St shoulders, ankles, knees, hips Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine (back, neck), wrists, handsPhone: (405) 947-0911 Fax: (405) 948-5171
American Board of OrthopedicSurgery
T
Orthopedic Surgery Winston Fong, M.D. 1110 N Lee spine only (cervical, thoracic, OKC, Edmondlumbar)Oklahoma City, OK73103
[email protected]. Body Parts/Svcs:Contact: Brendaall except spinePhone: (405) 230-9746 Fax: (405) 230-9421(shoulders,elbows,hands,hips,knees,ankles/feet)
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 50
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Dennis E. Foster, M.D. 3130 SW 89 St Ste 100 all Oklahoma CityOklahoma City, OK73159-7900
Excl. Body Parts/Svcs:Contact: NonePhone: (405) 378-4472 Fax: (405) 378-3580
American Board of OrhtopedicSurgery
T R MITF
Orthopedic Surgery Jeff A. Fox, M.D.* 6585 S Yale Ave Ste 200 knees, ankles, elbow, shoulders TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: appt desk hand, spinePhone: (918) 481-7658 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Sami R. Framjee, M.D. 2000 S Wheeling Ave Ste 1110 spine and general orthopaedics TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Teri NonePhone: (918) 294-0080 Fax: (918) 742-2119
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 51
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Joel L. Frazier, M.D.* 1044 SW 44 St Ste 600 hands, upper extremities, elbows, Oklahoma CitywristsOklahoma City, OK73109
[email protected]. Body Parts/Svcs:Contact: eRNESTall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Charles H. Funderburk, M.D.* 1110 N Lee hands, shoulders, elbows, knees, Oklahoma Ctiy,wrists, forearm EdmondOklahoma City, OK73103-2612
[email protected]. Body Parts/Svcs:Contact: neck, back, hips, feetPhone: (405) 230-9743 Fax: (405) 522-9474
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Timothy Michael Geib, M.D. 13800 Benson Rd Ste 201 knees, shoulders, elbows, hips, Edmond, OKChands, armsEdmond, OK73103
[email protected]. Body Parts/Svcs:Contact: Brookefeet, backPhone: (405) 517-3719 Fax: ( ) -
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 52
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Robert A. German, M.D. 1110 N Lee knees, shoulders, elbows, ankles, Oklahoma City,arms, legs NormanOklahoma City, OK73103-2612
[email protected]. Body Parts/Svcs:Contact: Jenniferback, neckPhone: (405) 230-9270 Fax: (405) 230-9600
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Greg Halko, M.D.* 3301 NW 50 hands, upper extremities Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) and lower
extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Kevin Wayne Hargrove, M.D. 101 S Saints Blvd Ste 101 shoulders, knees, elbows EdmondEdmond, OK73034
[email protected] Excl. Body Parts/Svcs:Contact: Leanna, Gena spine, hip, hand, foot & no psy
overlayPhone: (405) 749-8326 Fax: (405) 749-8328
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 53
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Bryan Hawkins, M.D.* 6585 S Yale Ave Ste 200 ankles, knees, feet, hip TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: CSOS neck, spine, wrists, hands, elbowsPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Don L. Hawkins, M.D. 6585 S Yale Ave Ste 200 neck and spine TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Shann, Brian knees, hips, hands, shoulders,
anklesPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Randall L. Hendricks, M.D. 6585 S Yale Ste 200 neck, spine TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Allison shoulders, elbows, hips, knees
hands, wrists, anklePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 54
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery David R. Hicks, M.D. 6585 S Yale Ave Ste 200 neck and spine TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Central States Orthopedics hands, wrists, elbows, shoulders,
knees, hips, anklesPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Robert Frazer Hines, M.D. 1616 S Kelly shoulders, knees EdmondEdmond, OK73013
[email protected] Excl. Body Parts/Svcs:Contact: Naci hips, elbow, back, foot/anklePhone: (405) 348-6004 Fax: (405) 715-8853
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Gregory R. Holt, M.D. 1809 E 13 St Ste 100 hips, knees, shoulders TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae Cheatham spinePhone: ( ) - Fax: (918) 582-6060
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 55
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Thomas C. Howard, M.D.* 1110 N Lee hands, shoulders, knees, hips and Oklahoma City,feet NormanOklahoma City, OK73103-2612
[email protected]. Body Parts/Svcs:Contact: schedulingspine, (neck,back)Phone: (405) 230-9752 Fax: (405) 230-9424
American Board of OrthopedicSurgery
T R
Orthopedic Surgery John B. Hughes, D.O. 2149 SW 59 St Ste 102 all Oklahoma CityOklahoma City, OK73119
[email protected] Excl. Body Parts/Svcs:Contact: Tammy nonePhone: (405) 682-5351 Fax: (405) 685-5563
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Christopher Shane Hume, D.O. 10001 S. Western Ave spine (neck & back) Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: scheduler all except specialityPhone: (405) 427-3705 Fax: ( ) -
Board EligibleT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 56
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Antoine I. Jabbour, M.D. 4802 S 109 E Ave knees, shoulders TulsaTulsa, OK74146
[email protected] Excl. Body Parts/Svcs:Contact: Latoya spine, handsPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Paul Jacob, D.O. 1616 S. Kelly Ave. adult reconstruction total joint EdmondreplacementEdmond, OK73013
[email protected]. Body Parts/Svcs:Contact: Joann Ellisuper extremity injuriesPhone: (405) 715-8803 Fax: ( ) -
Certification UnknownT R MITF
Orthopedic Surgery Thomas P. Janssen, M.D. 1110 N Lee knees, hips, shoulders, feet, hands Oklahoma CityOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: appt scheduling 405-230-9270 neck,backPhone: (405) 230-9743 Fax: (405) 230-9474
American Board of Family Medicine &Orthopaedic Surgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 57
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery J. Calvin Johnson, M.D. 6205 N Santa Fe Ste 200 knees, shoulders Oklahoma CityOklahoma City, OK73118
[email protected] Excl. Body Parts/Svcs:Contact: Jennifer back,hands,anklesPhone: (405) 419-5412 Fax: (405) 419-5468
American Board of OrthopedicSurgery
T
Orthopedic Surgery Wayne A. Johnson, M.D. 8212 NW Stonebridge Ct shoulder, knee, hand/wrist, Lawtonfoot/ankleLawton, OK73506
[email protected]. Body Parts/Svcs:Contact: CassandrabackPhone: (580) 536-2265 Fax: (580) 536-7805
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Daniel J. Jones, M.D. 8100 S Walker Ave Bldg A knee, shoulder, foot, ankle, legs, Oklahoma Cityarms, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: JuliespinePhone: (405) 632-4468 Fax: (405) 632-4317
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 58
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Michael E. Kiehn, M.D. 3301 NW 50 St knees, shoulders Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Jaye Dee Watts spine (neck, back)Phone: (405) 947-0911 Fax: (405) 942-5043
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Norman,hips, ankles, arms Oklahoma CityNorman, OK73072
[email protected]. Body Parts/Svcs:Contact: BrookespinePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Zakary A. Knutson, M.D. 3400 W Tecumseh Ste 101 hips, knees, shoulders, elbows Norman, EdmondNorman, OK73072
[email protected] Excl. Body Parts/Svcs:Contact: Brooke foot, ankle, neck and backPhone: (405) 517-3719 Fax: ( ) -
Certification UnknownT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 59
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Mark F. Kowalski, M.D. 4140 W Memorial Rd Ste 308 all orthopaedic surgery except Oklahoma Cityspine, hips, and neckOklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Kayla, Shawna, Cathyhips, back, neckPhone: (405) 749-7031 Fax: (405) 749-7036
American Board of OrthopedicSurgery
T R
Orthopedic Surgery E. Alexander L'Heureux, Jr., M.D. 1405 NW 150 St cervical, thoracic and lumbar spine EdmondEdmond, OK73013
Excl. Body Parts/Svcs:Contact: Jennifer all except spinePhone: (405) 844-5222 Fax: (405) 744-2166
American Board of OrthopedicSurgery & Spine Surgery
T
Orthopedic Surgery Ronald S. LaButti, D.O.* 6585 S Yale Ave Ste 200 hips, knees, ankles, foot TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: appt desk hand, elbow, arms, shouldersPhone: (918) 481-2767 Fax: (918) 481-7611
American Osteopathic Aacademy ofOrthopedics
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 60
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Bradley J. Lawson, M.D. 6585 S Yale Ave Ste 200 ankle, shoulder, hip, knee, foot, Tulsaelbow, hand, wristTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: schedulingnonePhone: (918) 481-2767 Fax: ( ) -
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Brian A. Levings, D.O. 8100 S Walker Ave Bldg A arms, legs, shoulders, knees, feet, Oklahoma Cityankles, elbowsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: WALTback, neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Osteopathic Board ofOrthopaedic Surgery
T R MITF
Orthopedic Surgery Alan G. Lewis, M.D. 6475 S Yale Ave Ste 301 feet, ankles, knees TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: CJ/Linda spine, hips, hands, elbows,
shoulders, rate only casesPhone: (918) 494-9351 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 61
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery J. Patrick Livingston, M.D. 1211 N Shartel Suite 500 orthopedic surgery, neck, back, Oklahoma Cityshoulders, hips, arms, legs, hands,Oklahoma City, OK73103feet
Contact: AllisonExcl. Body Parts/Svcs:Phone: (405) 463-0407 Fax: (405) 463-0425head, brain, lungs, hearturogenital, gastrointestinal
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Jay D. Lorton, M.D. 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Lori Pile spine, hands, hips, feetPhone: (918) 494-9384 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Paul D. Maitino, D.O. 3110 SW 89 Street Ste 200D hips, knees, shoulders Oklahoma CityOklahoma City, OK73159
[email protected] Excl. Body Parts/Svcs:Contact: Jessica headPhone: (405) 680-5633 Fax: (405) 735-6435
Orthopedic SurgeryT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 62
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Bradley Margo, M.D. 1110 N Lee shoulders, knees Oklahoma CityOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: Central Sched 405-230-9270 backs, necks, hips, feet, handsPhone: (405) 230-9000 Fax: ( ) -
American Board of OrthopaedicSurgery
T R
Orthopedic Surgery James C. Mayoza, M.D. 6122 E 61 St lumbar and cervical spine & TulsaextremitiesTulsa, OK74136-2117
Contact: Nicci or MorgiePhone: (918) 492-3133 Fax: (918) 493-2215
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery James D. Mitchell, M.D. 1110 N Lee hips, knees OKC, NormanOklahoma City, OK73103
[email protected] Excl. Body Parts/Svcs:Contact: shoulders, wrists, elbows, hands,
feet, spinePhone: (405) 230-9600 Fax: (405) 230-9424
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 63
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Yogesh Mittal, M.D. 1809 E 13 St Ste 100 hips, knees TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae spinePhone: (918) 582-6800 Fax: (918) 301-4293
American Board of OrthopaedicSurgery
T R
Orthopedic Surgery Mac E. Moore, M.D. 10001 S Western Ste 200 shoulders, elbows, knees Oklahoma CityOklahoma City, OK73139-2997
Excl. Body Parts/Svcs:Contact: Belinda nonePhone: (405) 692-3737 Fax: (405) 692-3707
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Jeffrey R. Morris, D.O.* 6585 S. Yale Ave Suite 200 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: Reggie 918-583-7076neck, spinePhone: (918) 481-2767 Fax: (918) 583-7908
American Osteopathic Board ofOrthopedfic Surgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 64
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Mark Robert Moses, M.D. 825 E Robinson hips, knees, shoulders,hands, NormanwristsNorman, OK73071
[email protected]. Body Parts/Svcs:Contact: Gayleneneck, backPhone: (405) 364-7900 Fax: (405) 366-6214
American Board of OrthopaedicSurgery
T R
Orthopedic Surgery Gene L. Muse, M.D. 4200 W Memorial Rd Ste 1001 shoulders, knees, hips Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Penny (spine) back, neckPhone: (405) 787-7678 Fax: (405) 751-3367
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Ryan L. Nelson, D.O 1616 S. Kelly shoulder, elbow, knee Edmond(trauma/fractures) hip, wrist,Edmond, OK73013ankle
Contact: JoannExcl. Body Parts/Svcs:Phone: (405) 330-8847 Fax: ( ) -none
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 65
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery David E. Nonweiler, M.D. 6585 S Yale Ave Ste 200 shoulders, knees TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Melissa neck and spinePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery M. Sean O'Brien, D.O.* PO Box 890358 hands and shoulders Oklahoma CityOklahoma City, OK73189
Excl. Body Parts/Svcs:Contact: Marilyn back, neck, feetPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery James M. Odor, M.D. 14100 Parkway Commons Dr Ste 200 cervical, thoracic & lumbar spine Oklahoma City(neck and back)Oklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Valerie, ReneeNonePhone: (405) 242-4345 Fax: (405) 242-4333
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 66
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery L. Todd Olsen, D.O. Olsen Orthopedics knees, shoulders MWC3400 S Douglas Blvd Ste 302Oklahoma City, OK73150 Excl. Body Parts/Svcs:
Contact: Wendy, Cheryl backsPhone: (405) 733-8000 Fax: (405) 733-7820
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 knees, shoulders TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae spine, foot/ankle, hand/elbowPhone: (918) 925-3226 Fax: ( ) -
American Osteopathic BoardT R
Orthopedic Surgery Kris Parchuri, D.O. 9101 S Toledo Ave Ste B spine TulsaTulsa, OK74137
sostulsa.com Excl. Body Parts/Svcs:Contact: Sarah hands, feetPhone: (539) 664-4448 Fax: (539) 664-4288
AOAT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 67
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Andrew Parkinson, M.D. 3301 NW 50 St spine, (neck, back), lower Oklahoma CityextremitiesOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: central schedulingall except spine & lowerPhone: (405) 947-0911 Fax: ( ) -extremities
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Corey Eugene Ponder, M.D. 13800 Benson Rd Ste 201 joint replacement and revision Edmond(knees and hips only)Edmond, OK73013
[email protected]. Body Parts/Svcs:Contact: Brookeall except knees, hipsPhone: (405) 517-3719 Fax: ( ) -
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand Oklahoma CityOklahoma City, OK73112-4418
Excl. Body Parts/Svcs:Contact: backPhone: (405) 945-4888 Fax: (405) 945-4887
American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 68
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Vytautas M. Ringus, M.D. 825 E Robinson foot and ankle NormanNorman, OK73071
[email protected] Excl. Body Parts/Svcs:Contact: Donna nonePhone: (405) 364-8855 Fax: (405) 310-6866
Certification UnknownT R
Orthopedic Surgery R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 neck, spine, shoulder, elbows, Tulsawrists, hips, knees, anklesTulsa, OK74136
[email protected]: Phone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Richard A. Ruffin, M.D.* 3301 NW 50 hands, wrists, elbows, shoulders Oklahoma CityOklahoma City, OK73112-5691
Excl. Body Parts/Svcs:Contact: Central Scheduling neck & back (spine), feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263
American Board of OrthopedicSurgery, Hand Surgery
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 69
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery David Saxton, M.D. 1110 N Lee knees, shoulders, elbows OKC, Norman,EdmondOklahoma City, OK73103
[email protected] Excl. Body Parts/Svcs:Contact: Vickie hands, spine, hipsPhone: (405) 230-9437 Fax: (405) 230-9421
American Board of OrthopaedicSurgery & Sports Medicine
T R
Orthopedic Surgery Steven Schultz, M.D. 825 E Robinson hips, knees (total hip replacement Norman& total knee replacement)Norman, OK73071
[email protected]. Body Parts/Svcs:Contact: Donnaback, neckPhone: (405) 364-8855 Fax: ( ) -
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Houshang Seradge, M.D.* 1044 SW 44 Street Suite 518 spine, foot, wrist, elbow, Oklahoma Cityshoulder, hip, knee, ankleOklahoma City, OK73109
Contact: MistiPhone: (405) 634-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 70
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Blake Shockley, M.D. 9716 S. Riverside Drive Ste 101 shoulder, elbow, hip, knee and Tulsa areaankleJenks, OK74137
[email protected]. Body Parts/Svcs:Contact: Jennifer. Angiespine, handPhone: (918) 528-3300 Fax: ( ) -
Certification UnknownT R MITF
Orthopedic Surgery James C. Slater, M.D. 4802 S 109 E Ave adult reconstruction TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya hands, feet,back, neck, (spine)Phone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Glenn L. Smith, D.O. 2149 SW 59 Ste 101 all orthopedic surgery Oklahoma CityOklahoma City, OK73119
[email protected] Excl. Body Parts/Svcs:Contact: Linda NonePhone: (405) 682-4651 Fax: (405) 682-3391
Orthopedic SurgeryT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 71
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Sheryl C. Smith, M.D. 6205 N Santa Fe Ste 200 foot, ankle Oklahoma CityOklahoma City, OK73118
Excl. Body Parts/Svcs:Contact: Kim all except foot & anklePhone: (405) 419-5610 Fax: (405) 419-5429
Certification UnknownT R
Orthopedic Surgery Cheng-Lun Soo, M.D. 1044 SW 44 Street spine, neck, lumbar, cervical Oklahoma CityOklahoma City, OK73109
[email protected] Excl. Body Parts/Svcs:Contact: Ernest all except neck and backPhone: (405) 631-4263 Fax: (405) 631-1767
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Richard M. Stamile, M.D. 4802 S 109 E Ave #100 general orthopedics no surgery TulsaTulsa, OK74146
[email protected] Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 72
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Wesley Michael Stotler, D.O. 4802 S 109 E Ave foot, ankle TulsaTulsa, OK74146
[email protected] Excl. Body Parts/Svcs:Contact: Latoya all except feet and anklesPhone: (918) 392-1437 Fax: (918) 392-1401
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery Richard D. Thomas, M.D. 4802 S 109 E Ave spine (neck, back) TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya all except back & neckPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Robert S. Unsell, M.D. 10001 S Western Ste 101 hands, wrist, elbows Oklahoma CityOklahoma City, OK73139
[email protected] Excl. Body Parts/Svcs:Contact: Darcy spine, lower extremitiesPhone: (405) 692-3748 Fax: (405) 923-3783
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 73
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical Tulsa, OKCmaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-TayllerNonePhone: (918) 488-8285 Fax: (405) 949-1801
Certification UnknownT R MITF
Orthopedic Surgery David K. Wong, M.D. 6585 S Yale Ave Ste 200 hands, wrists, elbows, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Patti neck, spine, knees, hips, anklesPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Michael Wright, M.D. 3115 SW 89 spine Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Krista NonePhone: (405) 424-5630 Fax: (405) 692-1632
American Board of Spine SurgeryT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 74
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Gregory J. Zeiders, D.O. 1600 Medical Center Drive hands, wrists, elbows, shoulders, Edmond,feet, ankles, knees, hips Shawnee,Edmond, OK73034
Oklahoma [email protected]. Body Parts/Svcs:Contact: LindsayspinePhone: (405) 359-2266 Fax: (405) 341-1578
American Osteopathic Board ofOrthopedic Surgery
T R
Orthopedics Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 shoulder, knee, foot, ankle TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae spine, handPhone: (918) 925-3226 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T
Orthopedics Joel M. Davis, M.D. 3301 NW 50 Street lower extremities, feet, ankles OKCOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling neck, backPhone: (405) 947-0911 Fax: (405) 947-1341
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 75
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedics William Bentley Edmonds, M.D. 1110 N Lee foot, ankle Oklahoma City,Edmond, NormanOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: Chiquita, Cindy all except foot and anklePhone: (405) 230-9745 Fax: (405) 230-9424
American Board of OrthopaedicSurgery
T R
Orthopedics David Holden, M.D. 1110 N Lee knees & shoulders only Oklahoma CityOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: Lynn back & neckPhone: (405) 230-9406 Fax: ( ) -
American Board of OrthopaedicSurgery & Sports Medicine
T
Orthopedics Michael Brandon Johnson, M.D. 6205 N. Santa Fe Suite 200 all within specialty OKCOklahoma City, OK73118
Excl. Body Parts/Svcs:Contact: Debra Lewis SpinePhone: (405) 427-6776 Fax: ( ) -
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 76
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedics Faustino Kazenske, D.O. 3301 NW 50th Street Lower extremities, hips, knees Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Central Scheduling Upper extremities and backPhone: (405) 947-0911 Fax: ( ) -
Certification UnknownT R MITF
Orthopedics Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hips, ankles, arms NormanNorman, OK73072
[email protected]. Body Parts/Svcs:Contact: BrookespinePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
Orthopedics John Wheeler, M.D. 3115 SW 89 all within specialty Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Kim nonePhone: (405) 424-5630 Fax: ( ) -
American board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 77
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Otolaryngology R. Stanley Baker, M.D. 3400 NW 56 St ears Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Dawn all other than earsPhone: (405) 946-5563 Fax: ( ) -
American Board of OtolaryngologyT R
Otolaryngology Alen Munson Fuller, M.D. 1725 E 19 St Ste 100 ears (cumulative hearing loss) TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Betsi surgical casesPhone: (918) 742-7376 Fax: (918) 743-2117
American Board of OtolaryngologyT R
Otolaryngology John R. Houck, M.D. 920 Stanton L Young WP 1290 ear, nose, throat OKCOklahoma City, OK73104
Excl. Body Parts/Svcs:Contact: Tiffney complaints of dizzinessPhone: (405) 271-5504 Fax: (405) 271-3248
American Board of OtolaryngologyT
Otolaryngology Paul David Hunter, M.D.* 535 NW 9th Street #300 Ears, nose, throat and facial Oklahoma CitytraumaOklahoma City, OK73102
[email protected]. Body Parts/Svcs:Contact: Dianne Hunterall others but listedPhone: (405) 272-6027 Fax: (405) 272-8315
AM Board of OtolaryngologyT
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 78
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Otology Mark Wood, M.D. 3400 NW 56 St ears, hearing, including dizziness Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Valoree anything other than earsPhone: (405) 946-5563 Fax: (405) 945-7185
American Board of OtolaryngologyT R
Physical Medicine and Donald E. Adams, M.D. 1616 S Kelly pain management Oklahoma City,Rehabilitation EdmondEdmond, OK73013-3651
[email protected] Excl. Body Parts/Svcs:Contact: Joann feet, anklesPhone: (405) 692-3700 Fax: (405) 330-0092
American Board of Medicine &Rehabilitation & Pain Medicine
T R MITF
Physical Medicine and Archana Barve, M.D. 3613 NW 56 STREET STE 140 sports medicine, physical medicine Oklahoma CityRehabilitation & rehabilitationOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: Staceyspinal cord injury with paraplegia,Phone: (405) 949-6481 Fax: (405) 795-5909quadriplegia
American Board of PhysicalMedicine/Rehabilitation
T
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 79
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Albert J. Bisson, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, spine, upper and Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120
[email protected]: Cecylia
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic mngmt, rsd
American Board of PhysicalMedicine/Rehabilitation
T R
Physical Medicine and Christopher Bouvette, M.D. 4120 W Memorial Rd Ste 118 physiatry, neck, spine, upper & Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120
[email protected]: Ceyclia
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management
American Board of PhysicalMedicine/Rehabilitation +
T R
Physical Medicine and Michael S. Brown, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, neck, spine Oklahoma CityRehabilitation upper and lower extremities, nerveOklahoma City, OK73120
and joint [email protected]: Cecylia
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management, RSD
American Academy of PhysicalMedicine/Rehab
T R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 80
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and A. E. Moorad, M.D.* 4221 S Western Ste 3010 all PM & R, pain managment Oklahoma CityRehabilitation Oklahoma City, OK73109
Contact: MarilynPhone: (405) 636-7450 Fax: (405) 631-2296
American Board of Internal MedicineT R MITF
Physical Medicine and Lam D. Nguyen, D.O. 9320 South Mingo Road all pain management TulsaRehabilitation Tulsa, OK74133
asalgueroa@advanced paintulsa.com Excl. Body Parts/Svcs:Contact: Scheduling nonePhone: (918) 879-1700 Fax: (918) 879-1701
American Board of Physical Medicineand Rehab
T
Physical Medicine and Darryl Dermot Robinson, M.D. 3110 SW 89 Ste 102 all within speciality Oklahoma CityRehabilitation Oklahoma City, OK73159
[email protected] Excl. Body Parts/Svcs:Contact: Lindsey NonePhone: (405) 703-4950 Fax: (405) 703-4955
American Board of Physical Medicineand Rehab-Pain Management
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 81
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Charles Shields, M.D. 330 S 5 St Ste 305 all physical medicine and EnidRehabilitation rehabilitation, all neuro-musculo-Enid, OK73701
skeletalContact: AmberPhone: (580) 242-1224 Fax: ( ) -
American Board of PhysicalMedicine/Rehabilitation
T R
Physical Medicine and Kathleen M. Sisler, M.D. 6585 S Yale Ave Ste 200 elbows, hands, knees, hips, neck, TulsaRehabilitation spine, feet, ankles, wrists,Tulsa, OK74136
shoulders (Physiatry)[email protected]: Allison
Excl. Body Parts/Svcs:Phone: (918) 481-2767 Fax: (918) 481-7669none
American Board of PhysicalMedicine/Rehabilitation
T R MITF
Physical Medicine and Michael Shawn Smith, M.D. 5100 N Brookline Ste 500 PM&R, spine, spinal cord and brain Oklahoma CityRehabilitation injuriesOklahoma City, OK73112
[email protected]: AleciaPhone: (405) 605-8780 Fax: (405) 605-8782
American Board of PhysicalMedicine/Rehabilitation
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 82
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Jonathan B. Stone, D.O. 700 NW 7 Street Ste 115 all within speciality chronic Oklahoma CityRehabilitation medication management, continuingOklahoma City, OK73102
medical maintenanceContact: Phone: (405) 601-5899 Fax: (405) 601-5903
American Board of Physical Medicineand Rehabilitation
T
Physical Medicine and D. Brent Tipton, M.D. 5100 N Brookline Ste 530 muscles and nerves Oklahoma CityRehabilitation Oklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Linda heart, lungs, GI, Renal, medical
maintenance, pain managementPhone: (405) 604-6652 Fax: (405) 604-6653
American Board of PhysicalMedicine/Rehabilitation/Electrodiagnos
T R
Plastic Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists
American Board of Plastic Surgery &Am Bd Plastic Surg of Hand
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 83
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Plastic Surgery Paul David Hunter, M.D.* 535 NW 9th Street #300 Ears, nose, throat and facial Oklahoma CitytraumaOklahoma City, OK73102
[email protected]. Body Parts/Svcs:Contact: Dianne Hunterall others but listedPhone: (405) 272-6027 Fax: (405) 272-8315
AM Board of OtolaryngologyT
Podiatry Armando A. Carro, D.P.M. 600 W 15 St foot, ankle EdmondEdmond, OK73013
Excl. Body Parts/Svcs:Contact: Darla NonePhone: (405) 348-4141 Fax: (405) 340-0686
Certification UnknownT
Podiatry David C. Cavallaro, D.P.M. 1044 SW 44 floor 6 feet, ankles and related structures Oklahoma CityOklahoma City, OK73109
[email protected] Excl. Body Parts/Svcs:Contact: Stephanie anything above the anklePhone: (405) 631-4263 Fax: (405) 616-2670
American Board of Podiatric SurgeryT
Podiatry Timothy Siegfried, D.P.M. 10229 E 96 Street North Ste 100 foot, ankle Owasso, SapulpaOwasso, OK74055
[email protected] Excl. Body Parts/Svcs:Contact: Becki none within specialtyPhone: (918) 494-2902 Fax: (918) 272-8922
American Board of Podiatric SurgeryT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 84
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Podiatry William K. Smith, D.P.M. 1627 N Kickapoo toes, feet, ankles Shawnee,Oklahoma CityShawnee, OK74804
Contact: Glenda, LoriPhone: (405) 275-8234 Fax: (405) 275-7298
American Board of Podiatric SurgeryT R MITF
Podiatry Richard J Traczyk, II, D.P.M. 4205 McAuley Blvd Ste 465 foot, ankle Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Lanae anything above the anklePhone: (405) 755-7600 Fax: (405) 755-7680
Certification UnknownT R MITF
Psychiatry Sarah E. Land, D.O. 3314 E 46 Street Ste 200 Psychiatry TulsaTulsa, OK74135
[email protected] Excl. Body Parts/Svcs:Contact: Jennifer nonePhone: (918) 591-2510 Fax: (918) 591-2511
American Board of Psychiatry &Neurology
MITF
Psychiatry Dominic Losacco, M.D. 6565 S Yale Ave Ste 706 all within psychiatric specialty TulsaTulsa, OK74136-8308
Contact: Mary, MitziePhone: (918) 491-5767 Fax: (918) 491-5771
American Board of Psychiatry andNeurology
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 85
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychiatry Siavash Nael, M.D. 4720 S Western Ave psychiatry Oklahoma CityOklahoma City, OK73109-3834
[email protected]: any staff memberPhone: (405) 634-5529 Fax: (405) 634-1673
American Board of Pyschiatry andNeurology
T
Psychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126
Contact: GaryPhone: (405) 271-8001 Fax: (405) 271-8802
American Board of ProfessionalPsychology/Clinical Neuropsych
T R
Psychology - Clinical Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehabilitation (nervous system, Tulsawhole body) Trauma RelatedTulsa, OK74136Disorders (pain stress, depression,brain)Contact: Suzan
Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 86
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychology - Clinical Douglas O. Brady, Ph.D.* 1401 SW Park Ridge Blvd Ste D medical psychology, neuropsychology LawtonevaluationsLawton, OK73505
[email protected]: D'AnnPhone: (580) 355-7474 Fax: (580) 355-6765
American Board of ProfessionalDisability
T R MITF
Psychology - Clinical R. Keith Green, Ph.D. 5929 N May Ave Ste 508 psychological evaluations and Oklahoma CitytherapyOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: VirginiaNonePhone: (405) 842-6446 Fax: (405) 842-5644
Certification UnknownT
Psychology - Clinical David E. Johnsen, Ph.D. 2601 NW Expway Ste 410 W psychological overlay, chronic Oklahoma Citypain, neuropsychologyOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: Lea or AngelaNonePhone: (405) 755-8576 Fax: (405) 755-6026
Certification UnknownT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 87
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychology - Clinical Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082Excl. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021
Certification UnknownT R MITF
Psychology - Clinical Doris Wise, Ph.D. 3441 W Memorial Ste 7 psychological: mood, coping, Oklahoma Cityadjustment, rehabOklahoma City, OK73134
[email protected]. Body Parts/Svcs:Contact: DebbienonePhone: (405) 286-6000 Fax: ( ) -
Certification UnknownT R MITF
Psychology Michael R. Basso, Ph.D.* Univ of Tulsa Dept of Psychology head/brain - diatnostic testing, Tulsapsychological overlay800 S Tucker Drive
[email protected] Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Dr. BassoNonePhone: (918) 631-3151 Fax: (918) 631-2833
ABPP - Clinical Neuropsychology R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 88
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychology Stephen D. Carella, Ph.D. 3035 NW 63 Ste 103 psychological overlay Oklahoma CityOklahoma City, OK73116
[email protected]: SuePhone: (405) 840-4212 Fax: (405) 840-4258
Certification UnknownT R MITF
Psychology Jeri Fritz, Ph.D. 624 S Boston Ste 311 psychological overlay TulsaTulsa, OK74119
[email protected] Excl. Body Parts/Svcs:Contact: Dr. Jeri Fritz PhysicalPhone: (918) 584-6694 Fax: (918) 584-6229
Certification UnknownT
Psychology Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082Excl. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021
Certification UnknownT R MITF
Pulmonary Diseases Dennis M. Parker, M.D. 3366 NW Expressway Ste 660 pulmonary (lungs) Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Lisa Burgess 405-947-3345 all except respiratory diseasePhone: (405) 917-5439 Fax: (405) 494-0849
American Board of InternalMedicine, Am Bd - Pulmonary Disease
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 89
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Radiology Douglas Preston Beall, M.D. 1800 Renaissance Blvd Second Floor interventional pain management of Edmondspine and jointsEdmond, OK73013
[email protected]. Body Parts/Svcs:Contact: schedulinggeneral medicinePhone: (405) 601-2325 Fax: (405) 359-2491
American Board of RadiologyT
Sports Medicine Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775
American Board of OrthopedicSurgery
T R MITF
Sports Medicine Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566
[email protected] Excl. Body Parts/Svcs:Contact: Pam back, neckPhone: (918) 994-4068 Fax: (918) 994-4095
Certification UnknownT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 90
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 shoulder, knee, foot, ankle TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae spine, handPhone: (918) 925-3226 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T
Sports Medicine Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: CJ spine, hips, feet, ankles, hands &
rate only casesPhone: (918) 494-9351 Fax: (918) 494-9397
American Board of OrthopedicSurgery/Sports Medicine
T R
Sports Medicine James D. Cash, M.D.* 6585 S Yale Ave Ste 200 knees, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: nonePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 91
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Jeff A. Fox, M.D.* 6585 S Yale Ave Ste 200 knees, ankles, elbow, shoulders TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: appt desk hand, spinePhone: (918) 481-7658 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Sports Medicine Troy A. Glaser, D.O. 6585 S Yale Ave Ste 200 spine, knees, ankles, shoulders & TulsafootTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: Appt DesktailbonePhone: (918) 481-7658 Fax: (918) 481-7611
American Board of Family MedicineT R MITF
Sports Medicine Bryan Hawkins, M.D.* 6585 S Yale Ave Ste 200 ankles, knees, feet, hip TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: CSOS neck, spine, wrists, hands, elbowsPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 92
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Ronald S. LaButti, D.O.* 6585 S Yale Ave Ste 200 hips, knees, ankles, foot TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: appt desk hand, elbow, arms, shouldersPhone: (918) 481-2767 Fax: (918) 481-7611
American Osteopathic Aacademy ofOrthopedics
T R MITF
Sports Medicine Gary Robert Lee, M.D.* 5577 South Lewis Ave all TulsaTulsa, OK74105
[email protected] Excl. Body Parts/Svcs:Contact: Gail NonePhone: (918) 749-0003 Fax: ( ) -
American Board of Family Medicine -Sports Medicine
T R MITF
Sports Medicine Jason M. Leinen, M.D.* 3115 SW 89 Street all family & sports medicine, pain Oklahoma CitymanagementOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: AmynonePhone: (405) 600-1411 Fax: (405) 600-1531
American Board of Family MedicineT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 93
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Jeffrey R. Morris, D.O.* 6585 S. Yale Ave Suite 200 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74136
[email protected]. Body Parts/Svcs:Contact: Reggie 918-583-7076neck, spinePhone: (918) 481-2767 Fax: (918) 583-7908
American Osteopathic Board ofOrthopedfic Surgery
T R MITF
Sports Medicine Venkatesh Movva, M.D.* 6565 S Yale Ste 212 pain management TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Michelle migrainesPhone: (918) 502-4008 Fax: (918) 502-4001
American Board of Internal MedicineT
Sports Medicine Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 knees, shoulders TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae spine, foot/ankle, hand/elbowPhone: (918) 925-3226 Fax: ( ) -
American Osteopathic BoardT R
* Physician has multiple specialties.
Date: 12/04/2015 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 15:52 (Alphabetical by Specialty) Page: 94
As of July 1, 2015
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 neck, spine, shoulder, elbows, Tulsawrists, hips, knees, anklesTulsa, OK74136
[email protected]: Phone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Urology Roy Warren Bankhead, M.D. 2349 N Thompkins prostate, kidney, bladder, penis, OKCvaginaBethany, OK73008
[email protected]. Body Parts/Svcs:Contact: Makaylaall within specialtyPhone: (405) 495-6134 Fax: (405) 787-8466
American Board of UrologyT
* Physician has multiple specialties.