list of qualified independent medical examiners ... specialty listing.pdfcontact: marce all except...
TRANSCRIPT
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 1
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Ahmed Amayem, M.D. 1145 SW 74 St, Bldg I Ste 100 pain management Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Melissa head injuries, abdominal pain,
complicated multi organ medicalPhone: (405) 632-1783 Fax: ( ) -cases
American Board of AnesthesiologyT
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 Grigory Chernyak, M.D. 105 S Bryant Ste 404 pain management EdmondEdmond, OK73034
gregory [email protected] Excl. Body Parts/Svcs:Contact: Marce all except specialtyPhone: (405) 431-0804 Fax: ( ) -
American Board of AnesthesiologyT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 2
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Richard A. DuBose, M.D. 2000 S Wheeling Ave Ste 600 all pain management TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: Pat all except pain managementPhone: (918) 742-7030 Fax: (918) 745-6284
American Board of AnesthesiologyT
Anesthesiology David P. Ellis, M.D. 701 NE 10 Street pain management/interventional pain Oklahoma Citymedicine/spinal cord stimulatorsOklahoma City, OK73104Excl. Body Parts/Svcs:Contact: JenniferheadachePhone: (405) 232-8003 Fax: ( ) -
American Board of Anesthesiology -Pain Medicine
T R MITF
Anesthesiology Terry M. Gile, D.O. 3204 W Okmulgee all pain management MuskogeeMuskogee, OK74401
Excl. Body Parts/Svcs:Contact: Pat all except pain managementPhone: (918) 742-7030 Fax: ( ) -
Am Osteopathic Board ofAnesthesiology/Pain Mngmt
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 3
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Frank J. Hackl, M.D. 2448 E 81 Street ste 363 Pain Management TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: Angie female health issuesPhone: (918) 477-5950 Fax: (918) 447-5951
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 Martin L. Martucci, M.D. 2000 S Wheeling Ste 600 pain management TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: Jamie None within specialtyPhone: (918) 742-7030 Fax: (918) 742-9958
American Board of AnesthesiologyT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 4
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Daniel G. Morris, D.O.* 2811 E 15 Street Ste 102 Pain Management Only TulsaTulsa, OK74104
okpainandwellness.comContact: schedulingPhone: (918) 935-3240 Fax: (918) 935-3241
American Osteopathic Board ofAnesthesiology-Pain Management
T R MITF
Anesthesiology Michael Chad Owens, D.O. 427 E Cherokee Interventional Pain Management Enid(total body)Enid, OK73701
Contact: BarbaraPhone: (580) 234-7246 Fax: ( ) -
American Board of AnesthesiologyT
Anesthesiology Jayen H. Patel, M.D. 2811 E 15 Street Ste 102 pain management (neck, back, leg, Tulsahand headaches, RSD)Tulsa, OK 7410-4
www.okpainandwellness.comExcl. Body Parts/Svcs:Contact: appt deskeye, foot, pelvis, elbow, rist,Phone: (918) 935-3240 Fax: (918) 935-3241brain, ear
American Board of AnesthesiologyT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 5
As of January 1, 2014
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 101 Pain Management Oklahoma CityOklahoma City, OK73139
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 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 R MITF
Anesthesiology Andreas "Andrew" Revelis, M.D. 2000 S Wheeling Ave Ste 600 pain management TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: Pat NonePhone: (918) 742-7030 Fax: (918) 742-9958
Certification UnknownT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 6
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Chiropractic Thomas Cate, D.C. 2828 E 51 Ste 103 neck, full spine, extremities TulsaTulsa, OK74105
Excl. Body Parts/Svcs:Contact: Dulcy nonePhone: (918) 747-2225 Fax: ( ) -
Certification UnknownT R
Chiropractic Michael A. Chiaffitelli, D.C. 10001 S Penn Bldg P Ste 170 all chiropractics - spine, Oklahoma CityextremitiesOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: Alishainternal organsPhone: (405) 681-2273 Fax: (405) 681-2274
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 7
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Craig A. Day, D.C. 3023 S HARVARD back TulsaTULSA, OK74114
Contact: SELFPhone: (918) 742-2094 Fax: ( ) -
Certification UnknownT
Chiropractic Lance B. Goodwin, D.C. PO Box 172 spine CatoosaCatoosa, OK74015
Excl. Body Parts/Svcs:Contact: Whitney, Nicolel NonePhone: (918) 266-6000 Fax: ( ) -
Certification UnknownT
Chiropractic Edward C. Holmes, D.C. 1400 S Fretz Ave Ste 130 cervical, thoracic, lumbar, sacrum, Edmondpelvis, upper extremities, lowerEdmond, [email protected]
Contact: selfExcl. Body Parts/Svcs:Phone: (405) 285-1429 Fax: ( ) -none
National Board of ChiropracticExaminers
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 8
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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 R
Chiropractic Hugh G. McClure, D.C. 401 Vandament Ave Ste 102 whole body Yukon, OklahomaCityYukon, OK73099
hugh @ hgmcclure.com 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: ( ) -
Certification UnknownT R MITF
Chiropractic Jim R. Muse, D.C. 6825 S Western spine Oklahoma CityOklahoma City, OK73139
Contact: Ann, PeggyPhone: (405) 634-1127 Fax: (405) 634-1177
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 9
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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 MITF
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
Chiropractic Ronald B. Tripp, D.C. 2400 Tee Circle all within specialty NormanNorman, OK73069
[email protected] Excl. Body Parts/Svcs:Contact: Sherri nonePhone: (405) 321-8530 Fax: (405) 321-1478
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 10
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic David B. Waggoner, D.C. 7000 NW Expressway Ste H chiropractic Oklahoma CityOklahoma City, OK73132
Excl. Body Parts/Svcs:Contact: Meaghan non-musculoskeletalPhone: (405) 773-1113 Fax: ( ) -
Certification UnknownT R
Dentistry Melvin Burnitt Baker, Jr., D.D.S. 7405 NW 23 St general dentistry BethanyBethany, OK73008
Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 787-5266 Fax: ( ) -
Certification Unknown
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 Bryan Chrz, D.D.S. 505 N 14 St all dental PerryPerry, OK73077
Contact: ShelleyPhone: (580) 336-2255 Fax: (580) 236-0362
American Board of ForensicOdonyology
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 11
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Dentistry Emile M. Farha, D.D.S. 1316 NW 150 Terrace general dentistry/oral diagnosis EdmondOklahoma City, OK73013
Contact: selfPhone: (405) 348-9911 Fax: ( ) -
Certification UnknownT
Dentistry Steven W. Hogg, D.D.S. 423 W Washington St mouth, teeth Broken ArrowBroken Arrow, OK74012
[email protected] Excl. Body Parts/Svcs:Contact: Beth NonePhone: (918) 455-8899 Fax: (918) 362-9997
Certification UnknownT R MITF
Dentistry Sterling H. Stalder, D.D.S 930 SW 107 Street dentistry Oklahoma CityOklahoma City, OK73170
[email protected] Excl. Body Parts/Svcs:Contact: Renee 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 12
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 head, neck, back, extremities, Oklahoma Citylungs, toxicologyOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: KellyheartPhone: (405) 917-5336 Fax: (405) 917-2250
American Board of Family MedicineT R MITF
Family Medicine Graciela C. Gallardo, M.D. 5101 W Memorial pain management Oklahoma CityOklahoma City, OK73142
Contact: TracyPhone: (405) 752-9600 Fax: ( ) -
American Board of Family MedicineT
Family Medicine Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195
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 Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 600-1411 Fax: (405) 600-1531
American Board of Family MedicineT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 13
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, Shawneephysical medicine andOklahoma City, [email protected]
Contact: Kendra, BrittanyExcl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial
American Board of Family Medicine &Sports Medicin
T
Family Medicine Michael L. Winzenread, M.D. 105 S Broadway Ste 408 all EdmondEdmond, OK73034
Excl. Body Parts/Svcs:Contact: NonePhone: (405) 816-6840 Fax: ( ) -
American Board of Family Practice R MITF
Family Practice T. Jeffrey Emel, M.D.* 6475 S Yale Ave Ste 301 all TulsaTulsa, OK74136-7824
Excl. Body Parts/Svcs:Contact: Linda rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397
American Board of FamilyPractice/Sports Medicine
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 14
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Practice Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195
American Board of Family Medicine -Sports Medicine
T R MITF
Family Practice Daniel G. Morris, D.O.* 2811 E 15 Street Ste 102 Pain Management Only TulsaTulsa, OK74104
okpainandwellness.comContact: schedulingPhone: (918) 935-3240 Fax: (918) 935-3241
American Osteopathic Board ofAnesthesiology-Pain Management
T R MITF
Family Practice Lance E. Rosson, D.O. 1211 N Shartel Ste 1104 all Oklahoma CityOklahoma City, OK73103
Excl. Body Parts/Svcs:Contact: Sharon NonePhone: (405) 236-1900 Fax: (405) 236-0362
American Board of Family PhysiciansT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 15
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
General Surgery Christopher D. Carey, M.D. 3400 NW Expressway Ste 420 specialty only Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Sharon all except specialtyPhone: (405) 713-9935 Fax: (405) 713-9936
American Board of SurgeryT
General Surgery Russell L. Hanan, Jr., M.D. 608 NW 9 STE 4204 general surgery Oklahoma CityOklahoma City, OK73102
Excl. Body Parts/Svcs:Contact: Peggy, Christina head, spine, orthopedicPhone: (405) 235-3245 Fax: (405) 235-6991
Certification UnknownT
General Surgery Ned D. Hemric, Jr., M.D. 3435 NW 56 Street Ste 707 OKCOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Jessica back painPhone: (405) 601-0300 Fax: (405) 601-0303
AMERICAN BOARD OF SURGERYT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 16
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Linda spine, elbows, shoulders, feet,
ankles, knees, hips, rate onlyPhone: (918) 494-5520 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, OK74104Excl. Body Parts/Svcs:Contact: Raeknees, back, neck, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293
American Osteopathic Board ofOrthopedic Surgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 17
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: BJ 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 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, OK73109Excl. Body Parts/Svcs:Contact: Stephanieall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 18
As of January 1, 2014
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
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 MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 19
As of January 1, 2014
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 MITF
Hand Surgery David B. Mokhtee, M.D. 9709 E 79th Street S hand surgery only TulsaTulsa, OK74133-4566
Excl. Body Parts/Svcs:Contact: Pam all expcept handsPhone: (918) 994-4068 Fax: (918) 994-4095
American Board of Surgery - HandSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 20
As of January 1, 2014
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 only Oklahoma CityOklahoma City, OK73189
Excl. Body Parts/Svcs:Contact: Cindy Burditt 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: back and lower extremitiesPhone: (405) 945-4888 Fax: (405) 945-4887
American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand
T R
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, feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263
American Board of OrthopedicSurgery, Hand Surgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 21
As of January 1, 2014
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 Ste 600 hands, wrists Oklahoma CityOklahoma City, OK73109-8121
Excl. Body Parts/Svcs:Contact: Denise all except hands & wristsPhone: (405) 631-4263 Fax: (405) 631-1767
American Board of OrthopedicSurgery
T R MITF
Hand Surgery Garrett Watts, M.D. 2950 S Elm Pl Ste 456 hands, wrists Broken ArrowBroken Arrow, OK74012
Excl. Body Parts/Svcs:Contact: Francine, Ashley backPhone: (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
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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 22
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Internal Medicine Richard Allen Hastings, II, D.O. 1851 E 71 Street all TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Kari, Andrea NonePhone: (918) 749-1720 Fax: (918) 746-0674
American College of OsteopathicInternists
T R MITF
Internal Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131
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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 23
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Internal Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda nonePhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
Internal Medicine Sidney Williams, M.D. 801 South Washington Street Internal Medicine/Pain Management StillwaterStillwater, OK74074
Excl. Body Parts/Svcs:Contact: headachesPhone: (405) 377-1121 Fax: (405) 624-9201
Certification UnknownT
Neurology Ellen E. Hope, M.D. 14100 Parkway Comons Dr Ste 102 head, neck, back, extremities, Oklahoma Cityspinal cordOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: ChristineNonePhone: (405) 270-0500 Fax: (405) 270-0597
American Board of Psychiatry andNeurology
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 24
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurology Howard R. Jarrell, M.D. 14100 Parkway Commons Dr Ste 103 spine, radiculopathy, EMG Oklahoma CityOklahoma City, OK73134
None Excl. Body Parts/Svcs:Contact: Kerri head, general neurologyPhone: (405) 841-1111 Fax: (405) 840-8380
American Board of Psychiatry andNeurology
T
Neurology Jay K. Johnson, D.O. 7134 S Yale Ave Ste 450 all within specialty TulsaTulsa, OK74136-6380
www.tulsaneuro.com Excl. Body Parts/Svcs:Contact: Jennifer, Adair all except specialtyPhone: (918) 743-2882 Fax: (918) 745-0323
American Osteopathic Board ofPsychiatry and Neurology
T
Neurology Douglas W. Kaplan, M.D. 4120 W Memorial Rd Ste 204 brain, spine, peripherel nerves Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Amanda all except neurological casesPhone: (405) 749-4270 Fax: (405) 749-4277
American Board of Psychiatry andNeurology
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 25
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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: Kandice 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
Excl. Body Parts/Svcs:Contact: Kelly neuological IME's onlyPhone: (405) 302-2661 Fax: (405) 302-2670
American Board of Psychiatry andNeurology
T
Neuropsychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126
Contact: DemareePhone: (405) 271-8001 Fax: (405) 271-8802
American Board of ProfessionalPsychology/Clinical Neuropsych
R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 26
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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 - Clinical James G. Scott, Ph.D.* PO Box 26901 brain/emotions Oklahoma CityOklahoma City, OK73126-0901
Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 271-5253 Fax: (405) 271-5759
American Board of ProfessionalPsychology
T 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: ( ) -Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 27
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Emge NonePhone: (918) 712-9004 Fax: (918) 712-9120
Certification Unknown R MITF
Neuropsychology Mickey S. Ozolins, Ph.D. 4140 W Memorial Rd Ste 601 brain Oklahoma CityOklahoma City, OK73120
[email protected]: SherriPhone: (405) 749-2870 Fax: (405) 749-2858
American Board of ProfessionalPsychology
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 28
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neuropsychology Terry G. Shaw, Ph.D. 7146 S Braden Ste 500 head, brain, psychological overlay TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Mary NonePhone: (918) 488-6165 Fax: (918) 488-8021
American Board of ProfessionalNeuropsychology
R
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 nerveTulsa, OK74132Excl. Body Parts/Svcs:Contact: Sheilahips, knees, jointsPhone: (918) 749-0962 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, OK74136Excl. Body Parts/Svcs:Contact: Laurieall except specialtyPhone: (918) 491-3521 Fax: ( ) -
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 29
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Shon W. Cook, M.D. 11317 S Western Ave Ste 300 brain, spine, nerves Oklahoma CityOklahoma City, OK73170
Contact: NicolePhone: (405) 310-6977 Fax: (405) 701-5006
American Board of NeurologicalSurgery
T
Neurosurgery Christopher G. Covington, M.D. Attn: Sheila Harless spine, brain, carpel tunnel Tulsa6802 S Olympia Ave Ste 300Tulsa, OK74132 Excl. Body Parts/Svcs:
Contact: Sheila extremitiesPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
T
Neurosurgery Allan S. Fielding, M.D. 2000 S Wheeling Ste 1110 head, neck, back, shoulder, hip, Tulsaknee, CTS, ulnar neuropathyTulsa, OK74104Excl. Body Parts/Svcs:Contact: Keeley, MelodyNeurosurgical Cases OnlyPhone: (918) 294-0080 Fax: ( ) -
American Board of NeurologicalSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 30
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Emily D. Friedman, M.D. 3433 NW 56 Ste 750 head, brain, spine, neck, carpal Oklahoma CitytunnelOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Danaall body parts not specifiedPhone: (405) 945-4902 Fax: (405) 945-4901
American Board of NeurologicalSurgery
T
Neurosurgery Eric S. Friedman, M.D. 4120 W Memorial Rd Ste 300 brain and carpal tunnel only Oklahoma CityOklahoma City, OK73120-9322
Excl. Body Parts/Svcs:Contact: Kelsey spine, shoulders, knees, lower
extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
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
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 31
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Michael Hahn, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), hands Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Tammy shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
Neurosurgery Brent N. Hisey, M.D. 14100 Parkway Commons Dr Ste 201 spine (neck, back), brain, carpal Oklahoma CitytunnelOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Alishaall except specialtyPhone: (405) 242-4720 Fax: (405) 242-4933
American Board of NeurologicalSurgery
T
Neurosurgery Donald D. Horton, M.D. 14100 Parkway Commons Dr Ste 201 spinal surgery (cervical/lumbar) Oklahoma Citycarpal tunnelOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Marie, Alishaall except cervical, lumbar, carpalPhone: (405) 242-4720 Fax: (405) 242-4765tunnel
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 32
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Neurosurgery Kyle Mangels, M.D. 6802 S Olympia Ave Ste 300 spine, brain, carpal tunnel. ulnar TulsanerveTulsa, OK74132Excl. Body Parts/Svcs:Contact: Sheila, Susiehips, knees, jointsPhone: (918) 749-0762 Fax: (918) 744-4246
American Board of NeurologicalSurgery
T R
Neurosurgery John S. Marouk, D.O. 2128 S Atlanta PL Ste 100 spine, brain only TulsaTulsa, OK74114
Excl. Body Parts/Svcs:Contact: all other body partsPhone: (918) 583-5131 Fax: (918) 592-0670
American Osteopathic Board ofSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 33
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Fadi F Nasr, M.D. 4120 W Memorial Rd, Ste 300 Spine (neck, back), hand Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Stephanie shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: ( ) -
Certification UnknownT
Neurosurgery Stan Pelofsky, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120
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: Laurieall except specialtyPhone: (918) 492-7587 Fax: (918) 492-4033
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 34
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Robert L. Remondino, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists (carpal tunnel) Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Linda shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671
American Board of NeurologicalSurgery
T
Neurosurgery W. Emery Reynolds, M.D. 4120 W Memorial Ste 208 head, spine Oklahoma CityOklahoma City, OK73120
Contact: SondraPhone: (405) 755-3540 Fax: ( ) -
American Board of NeurologicalSurgery
T
Neurosurgery Scott C. Robertson, M.D. 9060 Harmony Dr Ste E neurosurgical cases Midwest CityMidwest City, OK73130
Excl. Body Parts/Svcs:Contact: Cindy shuntsPhone: (405) 737-0203 Fax: (405) 737-0221
American Board of NeurologicalSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 35
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery James A. Rodgers, M.D. 6565 S Yale Ste 709 cervical & lumbar spine carpal Tulsatunnel (Services restricted toTulsa, OK74136opinions regarding the nature andextent of permanent impairment, andContact: Ritaor opinions in claims against thePhone: (918) 481-4965 Fax: (918) 481-4996multi injury trust fund.)
Excl. Body Parts/Svcs:brain, knees, shoulders
American Board of NeurologicalSurgery
R
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
Neurosurgery Stewart C. Smith, M.D. 3705 NW 63 ST STE 212 head & spine Oklahoma CityOklahoma City, OK73116
Excl. Body Parts/Svcs:Contact: Calie all except within specialtyPhone: (405) 945-4456 Fax: (405) 848-3210
American Board of NeurologicalSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 36
As of January 1, 2014
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 Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: CALLIE shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: ( ) -
American Board of NeurologicalSurgery
T
Neurosurgery Caple A Spence, M.D. 8121 National Ave Ste 210 head, neck, back MWCMidwest City, OK73110
SNSSOKC.com Excl. Body Parts/Svcs:Contact: Joy non-neurosurgicalPhone: (405) 455-3393 Fax: (405) 455-7162
American Board of NeurologicalSurgery
T
Neurosurgery Nathaniel Stetson, D.O. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120
Contact: MarleaPhone: (405) 748-3300 Fax: ( ) -
Certification UnknownT
Neurosurgery Qualls Stevens, D.O. PO Box 30585 all within specialty MWC, OKCMidwest City, OK 7314-0
Excl. Body Parts/Svcs:Contact: Marie, Angie aneurysmsPhone: (405) 455-3322 Fax: ( ) -
Certification UnknownT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 37
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Kevin R. Teal, M.D. 3705 NW 63 Street Ste 212 head & spinal disorders Oklahoma CityOklahoma City, OK73116
Excl. Body Parts/Svcs:Contact: Calie all except specialityPhone: (405) 945-4456 Fax: (405) 848-3210
American Board of NeurologicalSurgery
T R
Neurosurgery Robert E. Tibbs, M.D. 4120 W Memorial Rd Ste 300 TREATMENT AUTHORIZATION for neck,Oklahoma Cityback, wrists (carpal tunnel)Oklahoma City, OK73120Excl. 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
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 38
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Kelsey shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: ( ) -
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
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
Excl. Body Parts/Svcs:Contact: Pam arms, legs, hands, feetPhone: (918) 994-4068 Fax: (918) 994-4095
Am Board of OsteopathicNeurological Surgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 39
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Obstetrics and Gynecology Joe Paul Merritt, M.D. 5300 N Grand Ste 302 female genetalia Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Heather all except OB/GYNPhone: (405) 943-2376 Fax: (405) 942-1251
American Board of Obstretrics andGynecology
T
Occupational Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 head, neck, back, extremities, Oklahoma Citylungs, toxicologyOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: KellyheartPhone: (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, OK73115Excl. 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 40
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine William R. Gillock, M.D. 7170 S Braden Ste 175 all body parts TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Sharon nonePhone: (918) 481-0994 Fax: (918) 494-6747
American Board of Internal Medicine& Preventive Medicine
T R MITF
Occupational Medicine Russell J. Green, M.D. 1044 North Sheridan Road all TulsaTulsa, OK74115
[email protected] Excl. Body Parts/Svcs:Contact: Cherish eyes, ears, nose, throat (ENT) &
psychPhone: (918) 609-1600 Fax: (918) 609-1319
American Board of PreventiveMedicine/Occupational Medicine
T R MITF
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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 41
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131
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
Excl. Body Parts/Svcs:Contact: Jerri NonePhone: (405) 843-0610 Fax: (405) 843-0620
Certification Unknown R MITF
Occupational Medicine William D. Jones, M.D. 707 NW 13 St all occupational medicine (rating Oklahoma Cityonly)Oklahoma City, OK73103Excl. Body Parts/Svcs:Contact: Jeannefemale reproductive systemPhone: (405) 521-8604 Fax: (405) 521-8605
Certification Unknown R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 42
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine John A. Munneke, M.D. 36 W Memorial Ste B9 all including occupational Oklahoma City,medicine, MITF, Form 3, pain TulsaOklahoma City, OK73114management
Contact: JoAnne, KerriExcl. Body Parts/Svcs:Phone: (405) 755-9702 Fax: (405) 755-9718eyes
Certification UnknownT R MITF
Occupational Medicine Robert E. Paul, M.D. 6717 S Yale Ste 107 orthopedics/soft tissue injuries TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Linda NonePhone: (918) 496-1991 Fax: (918) 496-3433
Certification UnknownT R MITF
Occupational Medicine Carl B. Pettigrew, D.O. 1211 N Shartel Ste 500 all Oklahoma City,TulsaOklahoma City, OK73103
Excl. Body Parts/Svcs:Contact: Karen NonePhone: (405) 239-7766 Fax: (405) 235-4895
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 43
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine J. A. Snelling, D.O. PO Box 702738 Occupational Medicine (Services Tulsarestricted to providing opinionsTulsa, OK74170regarding the nature and extent ofpermanent impairment, if any,Contact: selfand/or opinions in combinedPhone: (918) 749-3187 Fax: (918) 491-9925disability claims.)
Excl. Body Parts/Svcs:cardiac
American Board of FamilyPhysicians, Am Board of PreventiveMed.
R MITF
Occupational Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda nonePhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
Occupational Medicine Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical OKC, TulsamaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-AmberNonePhone: (918) 488-8285 Fax: (405) 949-1801
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 44
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine LeRoy E. Young, D.O. PO Box 60129 all Oklahoma CityOklahoma City, OK73146-0129
[email protected] Excl. Body Parts/Svcs:Contact: Misty NonePhone: (405) 235-6200 Fax: (405) 235-6206
Occupational MedicineT 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
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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 45
As of January 1, 2014
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 knees, shoulders, ankles Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck, back), handsPhone: (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, Yukon, OKCelbows, knees, shouldersOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 46
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Pam nonePhone: (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: Latoya spine: back & neckPhone: (918) 392-1400 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Jack Beller, M.D. 3301 NW 50 St all orthopedics Oklahoma CityOklahoma City, OK73112
www.okortho.comContact: Central schedulingPhone: (405) 947-0911 Fax: ( ) -
American Board of OrthopaedicSergery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 47
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Linda spine, elbows, shoulders, feet,
ankles, knees, hips, rate onlyPhone: (918) 494-5520 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
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, hips, Norman,arms Oklahoma CityNorman, OK73072Excl. Body Parts/Svcs:Contact: BROOKEhands, feet, backPhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 48
As of January 1, 2014
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
Excl. Body Parts/Svcs:Contact: Linda spine, hips, feet, ankles, hands &
rate only casesPhone: (918) 494-5520 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
Excl. Body Parts/Svcs:Contact: Linda hands, hips, knees, feet, ankles
shoulders, elbows, no rate only casPhone: (918) 494-5520 Fax: (918) 494-9397
American Board of OrthopedicSurgery/AmBd Ortho Surg of theSpine
T R
Orthopedic Surgery Steven P. Brantley, M.D. 3301 NW 50th Street knees and shoulders Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: central scheduling Spine (neck and back)Phone: (405) 947-0911 Fax: ( ) -
Certification UnknownT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 49
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Christopher A. Browne, M.D. 6475 S Yale Ave Ste 301 hips, knees TulsaTulsa, OK74136-7824
Excl. Body Parts/Svcs:Contact: Linda hands, spine, feet, ankles,
shoulders, elbows, no rate onlyPhone: (918) 494-5520 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
Excl. Body Parts/Svcs:Contact: Linda feet, hands, hips, ankles, elbows,
shoulders, no rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
Orthopedic Surgery James D. Cash, M.D.* 6585 S Yale Ave Ste 200 knees, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Shann nonePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 50
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 upper extremities (shoulder down to Tulsafingers)Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Raeknees, back, neck, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293
American Osteopathic Board ofOrthopedic Surgery
T R
Orthopedic Surgery Kenneth Chekofsky, M.D. 6475 S Yale Ste 202 hands, wrists TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Sharon shoulders, back, neck, hips, knees,
feetPhone: (918) 494-4460 Fax: ( ) -
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Marchel Word Clements, D.O. 2950 S Elm Pl Ste 460 all orthopedic surgery except spine Broken Arrow,TulsaBroken Arrow, OK74012
Excl. Body Parts/Svcs:Contact: Sheree spine (neck, back)Phone: (918) 451-1100 Fax: ( ) -
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 51
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Brian Clowers, M.D. 3400 W Tecumseh Ste 101 foot, ankle OKC, NormanNorman, OK73072
Excl. Body Parts/Svcs:Contact: Brooke all except foot & anklePhone: (405) 517-3719 Fax: (405) 360-6769
Certification UnknownT R
Orthopedic Surgery Ashley Cogar, M.D. 6205 N Santa Fe Ste 200 elbow, wrist, hand Oklahoma CityOklahoma City, OK73118
Excl. Body Parts/Svcs:Contact: Diana, Jennifer spine, shoulder, hip, knee, ankle
or footPhone: (405) 427-6776 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
Excl. Body Parts/Svcs:Contact: Ashley all except spinePhone: (405) 703-7300 Fax: (405) 703-7333
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 52
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Jimmy Harold Conway, M.D. 10001S Western Ste 101 elbows, knees, shoulders Oklahoma CityOklahoma City, OK73139-2997
Excl. Body Parts/Svcs:Contact: Crystal spine, feet, handsPhone: (405) 692-3749 Fax: (405) 692-3789
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Steven D. Coupens, M.D. 6205 N Santa Fe Ste 200 shoulders, elbows, hands, hips, Oklahoma Cityknees, ankles, feetOklahoma City, OK73118Excl. Body Parts/Svcs:Contact: KatherinebackPhone: (405) 427-6776 Fax: (405) 419-5527
American Board of OrthopedicSurgery
T
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, elbows, shoulders,
hips, knees, ankles, feetPhone: (918) 481-2767 Fax: (918) 481-7669
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 53
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Stephen R. Davenport, M.D. 3301 NW 50 St knees, hips, feet, ankles, Oklahoma Cityincluding reconstructive surgeryOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Central Schedulingspine, (neck, back), handsPhone: (405) 947-0911 Fax: (405) 948-5177
American Board of OrthopedicSurgery
T R MITF
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
EdmondExcl. 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: Latoya back, neck, hands, kneesPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 54
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Ronald Matthew Dumigan, M.D. 1110 N Lee Knees, Shoulders, Elbows, ankles, Oklahoma Cityand EdmondOklahoma City, OK73103
Excl. Body Parts/Svcs:Contact: Amy Spine, Neck, HipPhone: (405) 230-9405 Fax: (405) 230-9421
American Board of OrthopedicSurgery
T
Orthopedic Surgery Rory C. Dunham, D.O. PO Box 890358 hand, knee, shoulder, ankle Oklahoma CityOklahoma City, OK73189
Excl. Body Parts/Svcs:Contact: Cindy back, neck feet, head, chestPhone: (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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 55
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Eugene G. Feild, M.D. 6600 S Yale Ste 1315 all within specialty TulsaTulsa, OK74136-3346
Contact: NancyPhone: (918) 481-7770 Fax: (918) 481-7797
American Board of OrthopedicSurgery
T R
Orthopedic Surgery David J. Flesher, M.D. 3301 NW 50 St knees, shoulders only Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck & back), hips, 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 Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: central scheduling spine (back, neck), wrists, hands,
hips, total knee replacementPhone: (405) 947-0911 Fax: (405) 948-5171
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 56
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Winston Fong, M.D. 1110 N Lee spine only (cervical, thoracic, OKC, Edmondlumbar)Oklahoma City, OK73034Excl. Body Parts/Svcs:Contact: Jenniferall except spinePhone: (405) 230-9490 Fax: ( ) -
American Board of OrthopaedicSurgery
T R
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
[email protected] Excl. Body Parts/Svcs:Contact: appt desk spinePhone: (918) 481-7658 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 57
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Sami R. Framjee, M.D. 2000 S Wheeling Ave Ste 1110 spine and general orthopaedics TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: NonePhone: (918) 294-0080 Fax: (918) 742-2119
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Joel L. Frazier, M.D.* 1044 SW 44 St Ste 600 hands, upper extremities, elbows, Oklahoma CitywristsOklahoma City, OK73109Excl. Body Parts/Svcs:Contact: Stephanieall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T
Orthopedic 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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 58
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Timothy Michael Geib, M.D. 13800 Benson Rd Ste 210 knees, shoulders, elbows, hips, Edmond, OKChands, armsEdmond, OK73013Excl. Body Parts/Svcs:Contact: Brookefeet, backPhone: (405) 517-3719 Fax: ( ) -
Certification UnknownT R MITF
Orthopedic Surgery Robert A. German, M.D. 1110 N Lee knees, shoulders, elbows, ankles, Oklahoma City,arms, legs NormanOklahoma City, OK73103-2612Excl. Body Parts/Svcs:Contact: Jenniferback, neckPhone: (405) 230-9400 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
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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 59
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Kevin Wayne Hargrove, M.D. 10914 Hefner Pointe Dr Ste 200 shoulders, knees, elbows Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Julie neck, back, feet, hands-major
traumaPhone: (405) 749-8326 Fax: (405) 749-8328
American Board of OrthopedicSurgery
T R
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: Beth 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) 481-7654 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 60
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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, wristsPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
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: Denise, Linda hands, wrists, elbows, shoulders,
knees, hipsPhone: (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
Excl. Body Parts/Svcs:Contact: Melissa hips, hands, backsPhone: (405) 348-6004 Fax: (405) 715-8853
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 61
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Gregory R. Holt, M.D. 1809 E 13 St Ste 100 hips, knee, shoulders TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Tracy spine, handsPhone: (918) 925-3293 Fax: (918) 582-6060
American Board of OrthopedicSurgery
T R MITF
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
Excl. Body Parts/Svcs:Contact: Tammy nonePhone: (405) 682-5351 Fax: (405) 685-5563
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 62
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Christopher Shane Hume, D.O. 8100 S Walker Ave Bldg A spine (neck & back), carpal tunnel Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Julie all except specialityPhone: (405) 632-4468 Fax: (405) 632-4317
Board EligibleT R MITF
Orthopedic Surgery Antoine I. Jabbour, M.D. 4802 S 109 E Ave knees, shoulders TulsaTulsa, OK74146
None Excl. Body Parts/Svcs:Contact: Latoya spine, handsPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
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: Cynthia neck,backPhone: (405) 230-9743 Fax: (405) 230-9474
American Board of Family Medicine &Orthopaedic Surgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 63
As of January 1, 2014
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
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. PO Box 7137 shoulder, knee, hand/wrist, Lawtonfoot/ankleLawton, OK73506
[email protected]. Body Parts/Svcs:Contact: Cassandraback, neckPhone: (580) 695-9919 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 64
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery John F. Josephson, M.D. 4802 S 109 E Ave all except back, neck, hands TulsaTulsa, OK74146
None Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1404
American Board of OrthopedicSurgery
T
Orthopedic Surgery Michael E. Kiehn, M.D. 3301 NW 50 St knees, shoulders Oklahoma CityOklahoma City, OK73112
www.okortho.com Excl. Body Parts/Svcs:Contact: Central Scheduling 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, OK73072Excl. Body Parts/Svcs:Contact: BrookefeetPhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 65
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Zakary A. Knutson, M.D. 3400 W Tecumseh Ste 101 hips, knees, shoulders Norman, EdmondNorman, OK73072
[email protected] Excl. Body Parts/Svcs:Contact: Brooke all except hips, knees, shouldersPhone: (405) 517-3719 Fax: ( ) -
Certification UnknownT R
Orthopedic Surgery Mark F. Kowalski, M.D. 4140 W Memorial Rd Ste 308 all orthopaedic surgery except Oklahoma Cityspine, hipsOklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Kayla, Shawna, Cathyhips, spinePhone: (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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 66
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Ronald S. LaButti, D.O.* 6585 S Yale Ave Ste 200 hips, knees, ankles, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: appt desk backPhone: (918) 481-7658 Fax: (918) 481-7611
American Osteopathic Aacademy ofOrthopedics
T R MITF
Orthopedic Surgery Bradley J. Lawson, M.D. 6585 S Yale Ave Ste 200 ankle, shoulder, hip, knee, foot, Tulsa, OwassoelbowTulsa, OK74136Excl. Body Parts/Svcs:Contact: Shann, Amberneck, spine, handPhone: (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: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Osteopathic Board ofOrthopaedic Surgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 67
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Alan G. Lewis, M.D. 6475 S Yale Ave Ste 301 feet, ankles, knees TulsaTulsa, OK74136-7824
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
Orthopedic Surgery J. Patrick Livingston, M.D. 4205 McAuley Blvd Ste 301 general orthopedic evaluations, Oklahoma Citytreatment for non-surgicalOklahoma City, OK73120orthopedic cases
Contact: KendallExcl. Body Parts/Svcs:Phone: (405) 463-0407 Fax: (405) 463-0425jaws, ribs, internal medicine,psychological overlay
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Jay D. Lorton, M.D. 6475 S Yale Ave Ste 301 knees, shoulders, ankles, elbows TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Linda spine, hands, hips, feetPhone: (918) 494-5520 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 68
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Paul D. Maitino, D.O. 3110 SW 89 Street Ste 200D hips, knees, shoulders, hands , Oklahoma Citywrist, ankle, back, neckOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: KimberlyheadPhone: (405) 680-5633 Fax: (405) 735-6435
Orthopedic SurgeryT R MITF
Orthopedic Surgery Thomas A. Marberry, M.D. 4802 S 109 E Ave shoulders 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 Bradley Margo, M.D. 1110 N Lee shoulders, knees Oklahoma CityOklahoma City, OK73103-2612
Excl. Body Parts/Svcs:Contact: Central Scheduling backs, necks, hips, feetPhone: (405) 230-9000 Fax: ( ) -
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 69
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Corey E. Mayo, D.O. 13900 Quailbrook Drive knee, shoulder, arm, leg Oklahoma CityOklahoma City, OK73134-1718
[email protected] Excl. Body Parts/Svcs:Contact: Tanya spinePhone: (405) 418-4500 Fax: ( ) -
Certification UnknownT R
Orthopedic Surgery James C. Mayoza, M.D. 6122 E 61 St spine & extremities TulsaTulsa, OK74136-2117
Excl. Body Parts/Svcs:Contact: Brenda handPhone: (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
Excl. Body Parts/Svcs:Contact: Pam shoulders, wrists, elbows, hands,
feet, spinePhone: (405) 230-9488 Fax: ( ) -
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 70
As of January 1, 2014
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]: RaePhone: (918) 925-3226 Fax: (918) 301-4293
American Board of OrthopaedicSurgery
T R
Orthopedic Surgery Mac E. Moore, M.D. 10001 S Western Ste 101 shoulders, elbows, knees Oklahoma CityOklahoma City, OK73139-2997
Excl. Body Parts/Svcs:Contact: Shellie spine, feetPhone: (405) 692-3737 Fax: (405) 692-3707
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Jeffrey R. Morris, D.O.* 802 S Jackson Ste 405 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74127
[email protected]. Body Parts/Svcs:Contact: Reggieneck, spinePhone: (918) 583-4400 Fax: (918) 583-7908
American Osteopathic Board ofOrthopedfic Surgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 71
As of January 1, 2014
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, OK73071Excl. Body Parts/Svcs:Contact: Ginaneck, 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 all except spine Oklahoma CityOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Penny (spine) back, neckPhone: (405) 787-7678 Fax: (405) 751-3367
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Robert W. Nebergall, D.O. 9709 E 79 St South arms, legs, shoulders, hands, Tulsaknees, feet, fingers, toesTulsa, OK74133Excl. Body Parts/Svcs:Contact: Pamback, neck, brainPhone: (918) 994-4068 Fax: (918) 994-4095
American Osteopathic Board ofOrthopedic Surgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 72
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Ryan L. Nelson, D.O 10001 S Western Ste 101 shoulder, elbow, knee Oklahoma City(trauma/fractures) hip, wrist,Oklahoma City, OK73139ankle
Contact: ToyeExcl. Body Parts/Svcs:Phone: (405) 692-3700 Fax: ( ) -none
Certification UnknownT R MITF
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 only Oklahoma CityOklahoma City, OK73189
Excl. Body Parts/Svcs:Contact: Cindy Burditt back, neck, feetPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 73
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery James M. Odor, M.D. 14100 Parkway Commons Dr Ste 200 cervical, thorasic & 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
Orthopedic Surgery L. Todd Olsen, D.O. Olsen Orthopedics knees, shoulders MWC3400 S Douglas Blvd Ste 305
[email protected] Oklahoma City, OK73150 Excl. Body Parts/Svcs:Contact: Andrea, 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 feet, fingers, back pelvis, neckPhone: (918) 925-3226 Fax: ( ) -
American Osteopathic BoardT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 74
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Kris Parchuri, D.O. 9101 S Toledo Ave Ste B spine TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: Danielle hands, feetPhone: (539) 664-4448 Fax: (539) 664-4288
Certification UnknownT R MITF
Orthopedic Surgery Andrew Parkinson, M.D. 3301 NW 50 St spine, (neck, back), lower Oklahoma CityextremitiesOklahoma City, OK73112Excl. 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, OKC(knees and hips only)Edmond, OK73013Excl. Body Parts/Svcs:Contact: Brookeall except knees, hipsPhone: (405) 517-3719 Fax: ( ) -
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 75
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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: back and lower extremitiesPhone: (405) 945-4888 Fax: (405) 945-4887
American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand
T R
Orthopedic Surgery Vytautas M. Ringus, M.D. 825 E Robinson foot and ankle NormanNorman, OK73071
Excl. Body Parts/Svcs:Contact: Donna hands, shouldersPhone: (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, elbows, wrists, hips, Tulsaknees, anklesTulsa, OK74136
[email protected]: PattiPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 76
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Fred M. Ruefer, M.D. 209 S 36 St bones & joints MuskogeeMuskogee, OK74401
Excl. Body Parts/Svcs:Contact: Katrina back, neckPhone: (918) 682-7717 Fax: (918) 682-9434
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, feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263
American Board of OrthopedicSurgery, Hand Surgery
T
Orthopedic Surgery David Saxton, M.D. 1110 N Lee knees, shoulders, elbows OKC, Norman,EdmondOklahoma City, OK73103
Excl. Body Parts/Svcs:Contact: Vickie hands, spinePhone: (405) 230-9437 Fax: ( ) -
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 77
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Steven Schultz, M.D. 825 E Robinson hips, knees (total hip replacement Norman& total knee replacement)Norman, OK73071Excl. 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 Ste 600 hands, wrists Oklahoma CityOklahoma City, OK73109-8121
Excl. Body Parts/Svcs:Contact: Denise all except hands & wristsPhone: (405) 631-4263 Fax: (405) 631-1767
American Board of OrthopedicSurgery
T 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, spinePhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 78
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Glenn L. Smith, D.O. 2149 SW 59 Ste 101 all orthopedic surgery Oklahoma CityOklahoma City, OK73119
Excl. Body Parts/Svcs:Contact: Linda NonePhone: (405) 682-4651 Fax: (405) 682-3391
Orthopedic SurgeryT R
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 only Oklahoma CityOklahoma City, OK73109
Excl. Body Parts/Svcs:Contact: Stephanie all except neck and backPhone: (405) 631-4263 Fax: (405) 631-1767
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 79
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Richard M. Stamile, M.D. 4802 S 109 E Ave general orthopedic 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
Orthopedic Surgery Wesley Michael Stotler, D.O. 4802 S 109 E Ave foot, ankle TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya all except feet and anklesPhone: (918) 392-1473 Fax: (918) 392-1401
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery Richard D. Thomas, M.D. 4802 S 109 E Ave Ste300 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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 80
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Robert S. Unsell, M.D. 10001 S Western Ste 101 hands, upper extremities Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Darcy spine, lower extremitiesPhone: (405) 692-3748 Fax: (405) 923-3783
Certification UnknownT R MITF
Orthopedic Surgery Derek L. West, D.O.* 8100 S Walker Ste A shoulders, knees, arms, legs, feet, Oklahoma Cityankles, hips, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Osteopathic Board ofOrthopedic Surgery
T R MITF
Orthopedic Surgery Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical Tulsa, OKCmaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-AmberNonePhone: (918) 488-8285 Fax: (405) 949-1801
Certification UnknownT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 81
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Orthopedic Surgery Gregory J. Zeiders, D.O. 1600 Medical Center Drive trauma & sports medicine Edmond,Oklahoma City,Edmond, OK73034ShawneeExcl. Body Parts/Svcs:
Contact: Lindsay, Sue spinePhone: (405) 359-2266 Fax: (405) 359-0215
American Osteopathic Board ofOrthopedic Surgery
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 82
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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 nonePhone: (918) 925-3226 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T R MITF
Orthopedics Stephen B. Conner, M.D. 1616 S Kelly all orthopedics/sports medicine okcexcept spineEdmond, OK73013Excl. Body Parts/Svcs:Contact: KarispinePhone: (405) 348-3201 Fax: (405) 348-3204
American Board of OrthopedicSurgery
T R
Orthopedics Joel M. Davis, M.D. 3301 NW 50 Street lower extremities, feet, ankles OKCOklahoma City, OK73112
www.okortho.com 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 83
As of January 1, 2014
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
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
Excl. Body Parts/Svcs:Contact: Lynn back & neckPhone: (405) 230-9406 Fax: ( ) -
American Board of OrthopaedicSurgery & Sports Medicine
T
Orthopedics Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hips, ankles, arms NormanNorman, OK73072Excl. Body Parts/Svcs:Contact: BrookefeetPhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 84
As of January 1, 2014
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
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
Excl. Body Parts/Svcs:Contact: Betsi, Loetta 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 Otolaryngology R
Otology Mark Wood, M.D. 3400 NW 56 St ears, hearing, including dizziness Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Valoree throat, sinus, anything other than
earsPhone: (405) 946-5563 Fax: (405) 945-7185
American Board of OtolaryngologyT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 85
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Donald E. Adams, M.D. 1616 S Kelly pain management Oklahoma City,Rehabilitation EdmondEdmond, OK73013-3651
Excl. Body Parts/Svcs:Contact: Joann feet, anklesPhone: (405) 330-0015 Fax: (405) 330-0092
American Board of Medicine &Rehabilitation & Pain Medicine
T R MITF
Physical Medicine and Archana Barve, M.D. 5701 N Portland Ave Ste 210 sports medicine, physical medicine Oklahoma City,Rehabilitation & rehabilitation EdmondOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Sergio, Laurenspinal cord injury with paraplegia,Phone: (405) 949-6481 Fax: (405) 604-6434quadriplegia
American Board of PhysicalMedicine/Rehabilitation
T
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
problemsContact: Cecylia
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic mngmt, rsd
American Board of PhysicalMedicine/Rehabilitation
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 86
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Christopher Bouvette, M.D. 4120 W Memorial Rd Ste 118 physicatry, neck, spine, upper & Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120
problemsContact: Ceyclia
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management, RSD
American Board of PhysicalMedicine/Rehabilitation +
T R
Physical Medicine and Kimberly Bouvette, M.D. 4120 W Memorial Rd Ste 118 physiatry, neck, spine, upper & Oklahoma CityRehabilitation lower extremities, nerve & jointsOklahoma City, OK73120
Excl. Body Parts/Svcs:Contact: Cecylianarcotic pain management, RSDPhone: (405) 748-4700 Fax: (405) 748-5638
American Board of PhyscialMedicine/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 problemsContact: 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: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 87
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Michael J. Carl, M.D. 105 S Bryant Ave Ste 301 comprehensive pain management, all EdmondRehabilitation chronic pain conditionsEdmond, OK73034
Excl. Body Parts/Svcs:Contact: Dixieabdominal, pudendal, testicularPhone: ( ) - Fax: ( ) -
American Board of Physical Medicineand Rehabilitation
T R MITF
Physical Medicine and J. Jason Jackson, M.D. 3330 NW 56 Street all within specialty Oklahoma CityRehabilitation Suite 612
Oklahoma City, OK73112 Excl. Body Parts/Svcs:Contact: Central Scheduling nonePhone: (405) 601-8810 Fax: (877) 795-8060
American Board of PhysicialMedicine/Rehabilitation
T R MITF
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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 88
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, ShawneeRehabilitation physical medicine andOklahoma City, OK73102
[email protected]: Kendra, Brittany
Excl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial
American Board of Family Medicine &Sports Medicin
T
Physical Medicine and Darryl Dermot Robinson, M.D. 3110 SW 89 Ste 102 all within speciality Oklahoma CityRehabilitation Oklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Lindsey NonePhone: (405) 703-4950 Fax: (405) 703-4955
American Board of Physical Medicineand Rehab-Pain Management
T R
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: Amber
Excl. Body Parts/Svcs:Phone: (580) 242-1224 Fax: ( ) -anything except listed services
American Board of PhysicalMedicine/Rehabilitation
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 89
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Contact: AleciaPhone: (405) 605-8780 Fax: (405) 605-8782
American Board of PhysicalMedicine/Rehabilitation
T R MITF
Physical Medicine and Jonathan B. Stone, D.O. 700 NW 7 Street Ste 115 all within speciality Oklahoma CityRehabilitation Oklahoma City, OK73102
Excl. Body Parts/Svcs:Contact: chronic medication management,
continuing medical maintenancePhone: (405) 601-5899 Fax: (405) 601-5903
American Board of Physical Medicineand Rehabilitation
T
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 90
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and D. Brent Tipton, M.D. 5100 N Brookline Ste 530 all within speciality, Oklahoma CityRehabilitation electrodiagnostic testingOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Lindaheart, lungs, GI, Renal, medicalPhone: (405) 604-6652 Fax: (405) 604-6653maintenance, fibromyalgia, headache
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
Plastic Surgery Garland Porterfield, M.D. 3727 NW 63 Ste 200 plastic surgery of hands, upper & Oklahoma Citylower extremities, face, head &Oklahoma City, OK73116neck
Contact: SusieExcl. Body Parts/Svcs:Phone: (405) 848-9700 Fax: (405) 848-7297None
American Board of Plastic Surgery,American Board of Surgery
R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 91
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Podiatry Armando A. Carro, D.P.M. 600 W 15 St foot, ankle EdmondEdmond, OK73013
[email protected] Excl. Body Parts/Svcs:Contact: Ann NonePhone: (405) 348-4141 Fax: (405) 340-0686
Certification UnknownT
Podiatry David C. Cavallaro, D.P.M. 7370 S Walker Ave feet, ankles and related structures Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Debra legPhone: (405) 631-2333 Fax: ( ) -
American Board of Podiatric SurgeryT
Podiatry Kenneth R. Golda, D.P.M. 1522 SW 89 St feet, ankles only Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Linda all except foot & anklePhone: (405) 691-6694 Fax: ( ) -
American Board of PodiatricOrthopedics
T R MITF
Podiatry Christopher J. Green, D.P.M. 13900 Quailbrook Drive feet/ankles (Podiatry/Surgery) Kingfisher,EdmondOklahoma City, OK73134-1718
Excl. Body Parts/Svcs:Contact: Rhonda all except specialtyPhone: (405) 463-4140 Fax: (405) 463-4143
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 92
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Podiatry William Dale Hall, D.P.M. 1104-8 S Air Depot Blvd feet, ankles Midwest CityMidwest City, OK73110
Contact: NitaPhone: (405) 733-2783 Fax: ( ) -
American Board of MultipleSpecialties in Podiatry
T
Podiatry Timothy Siegfried, D.P.M. 10229 E 96 Street North Ste 100 foot, ankle Owasso, SapulpaOwasso, OK74055
Excl. Body Parts/Svcs:Contact: Terri none within specialtyPhone: (918) 494-2902 Fax: ( ) -
American Board of Podiatric SurgeryT R MITF
Podiatry G. Trent Smith, D.P.M. 3330 NW 56 Street Ste 600 feet, ankles (Podiatry/Surgery) OKCOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Rhonda all except specialtyPhone: (405) 947-8041 Fax: ( ) -
Certification UnknownT R
Podiatry William K. Smith, D.P.M. 1627 N Kickapoo toes, feet, ankles Shawnee,Oklahoma CityShawnee, OK74804
Contact: Susan, ShawPhone: (405) 275-8234 Fax: (405) 275-7298
American Board of Podiatric SurgeryT R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 93
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Podiatry Richard J Traczyk, II, D.P.M. 4205 McAuley Blvd Ste 465 foot, ankle Oklahoma CityOklahoma City, OK73120
[email protected]: LanaePhone: (405) 755-7600 Fax: (405) 755-7680
Certification UnknownT R MITF
Podiatry Trenton Wallace, D.P.M. 1044 SW 44th St Ste 600 anything below the knee Oklahoma CityOklahoma City, OK40563-2168
Excl. Body Parts/Svcs:Contact: Tami anthing above the kneePhone: (405) 632-1680 Fax: ( ) -
Certification UnknownT
Psychiatry Michelle M. Holloway, M.D. 2000 E 15 Street Ste 400A all within speciality EdmondEdmond, OK40534-1169
Excl. Body Parts/Svcs:Contact: Stephen nonePhone: (405) 341-1697 Fax: ( ) -
Certification UnknownT R MITF
Psychiatry Sarah E. Land, D.O. 3314 E 46 Street Ste 200 Psychiatry TulsaTulsa, OK74135
Excl. Body Parts/Svcs:Contact: Emily nonePhone: (918) 591-2510 Fax: ( ) -
American Board of Psychiatry &Neurology
MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 94
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Psychiatry Siavash Nael, M.D. 4720 S Western Ave psychiatry Oklahoma CityOklahoma City, OK73109-3834
Contact: MistyPhone: (405) 634-5529 Fax: (405) 634-1673
American Board of Pyschiatry andNeurology
T
Psychiatry Ola Nawar, M.D. 1145 SW 74 Street Bldg I Ste 200 all within specialty, pain OKCmanagementOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: ShantelnonePhone: (405) 942-0411 Fax: (405) 942-0450
American Board of Psychiatry andNeurology
T
Psychiatry Peter A. Rao, M.D. 5544 S Lewis Ave Ste 600 Psychiatry, neuropsychiatry, Tulsaaddiction medicineTulsa, OK74105Excl. Body Parts/Svcs:Contact: Taylor, DannonePhone: (918) 747-4900 Fax: (918) 747-4903
American Board of PsychiatryandNeurology
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 95
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126
Contact: DemareePhone: (405) 271-8001 Fax: (405) 271-8802
American Board of ProfessionalPsychology/Clinical Neuropsych
R MITF
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: ( ) -Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
Psychology - Clinical Grady L. Blackwood, Ph.D. 3037 NW 63 Street Ste 255 clinical psycholology Oklahoma CityOklahoma City, OK73116
Excl. Body Parts/Svcs:Contact: self suicidal-homocidal casesPhone: (405) 843-8026 Fax: ( ) -
Certification UnknownT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 96
As of January 1, 2014
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 Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Lea NonePhone: (405) 755-8576 Fax: (405) 755-6026
Certification UnknownT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 97
As of January 1, 2014
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 James G. Scott, Ph.D.* PO Box 26901 brain/emotions Oklahoma CityOklahoma City, OK73126-0901
Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 271-5253 Fax: (405) 271-5759
American Board of ProfessionalPsychology
T 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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 98
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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
Psychology Stephen D. Carella, Ph.D. 3035 NW 63 Ste 103 psychological overlay Oklahoma CityOklahoma City, OK73116
Excl. Body Parts/Svcs:Contact: Sue all except specialtyPhone: (405) 840-4212 Fax: (405) 840-4258
Certification UnknownT R
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 R
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
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 99
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Pulmonary Diseases Dennis M. Parker, M.D. 3366 NW Expressway Ste 660 pulmonary (lungs) Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Brandy all except respiratory diseasePhone: (405) 917-5439 Fax: (405) 494-0849
American Board of InternalMedicine, Am Bd - Pulmonary Disease
T R MITF
Radiology Douglas Preston Beall, M.D. 1800 Renaissance Blvd Second Floor interventional pain management of Edmondspine and all jointsEdmond, OK73013
Contact: Kim or LoriPhone: (405) 601-2325 Fax: (405) 359-2491
American Board of RadiologyT
Radiology James R. Webb, M.D. 6550 E 71 Street Ste 200 Diagnostic Radiology, pain Tulsamanagement, spine & jointsTulsa, OK74133Excl. Body Parts/Svcs:Contact: ReesanonePhone: (918) 630-0660 Fax: (918) 364-9322
American Board of RadiologyT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 100
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
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
Excl. Body Parts/Svcs:Contact: Pam nonePhone: (918) 994-4068 Fax: (918) 994-4095
Certification UnknownT R
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 nonePhone: (918) 925-3226 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 101
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824
Excl. Body Parts/Svcs:Contact: Linda spine, hips, feet, ankles, hands &
rate only casesPhone: (918) 494-5520 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: Shann nonePhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Sports Medicine T. Jeffrey Emel, M.D.* 6475 S Yale Ave Ste 301 all TulsaTulsa, OK74136-7824
Excl. Body Parts/Svcs:Contact: Linda rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397
American Board of FamilyPractice/Sports Medicine
T R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 102
As of January 1, 2014
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
[email protected] Excl. Body Parts/Svcs:Contact: appt desk 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 DesknonePhone: (918) 481-7658 Fax: (918) 481-7611
American Board of Family MedicineT
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: Beth neck, spine, wrists, hands, elbowsPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 103
As of January 1, 2014
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, shoulders TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: appt desk backPhone: (918) 481-7658 Fax: (918) 481-7611
American Osteopathic Aacademy ofOrthopedics
T R MITF
Sports Medicine Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195
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 Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 600-1411 Fax: (405) 600-1531
American Board of Family MedicineT
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 104
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Jeffrey R. Morris, D.O.* 802 S Jackson Ste 405 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74127
[email protected]. Body Parts/Svcs:Contact: Reggieneck, spinePhone: (918) 583-4400 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 feet, fingers, back pelvis, neckPhone: (918) 925-3226 Fax: ( ) -
American Osteopathic BoardT R
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 105
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, Shawneephysical medicine andOklahoma City, [email protected]
Contact: Kendra, BrittanyExcl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial
American Board of Family Medicine &Sports Medicin
T
Sports Medicine R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 neck, spine, elbows, wrists, hips, Tulsaknees, anklesTulsa, OK74136
[email protected]: PattiPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Sports Medicine Derek L. West, D.O.* 8100 S Walker Ste A shoulders, knees, arms, legs, feet, Oklahoma Cityankles, hips, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Osteopathic Board ofOrthopedic Surgery
T R MITF
* Physician has multiple specialties.
Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 106
As of January 1, 2014
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Urology Roy Warren Bankhead, M.D. 2349 N Thompkins prostate, kidney, bladder (requests OKCrating only)Bethany, OK73008
www.urologycenters.comExcl. Body Parts/Svcs:Contact: ReneenonePhone: (405) 495-6134 Fax: (405) 787-8466
American Board of Urology R
Urology Stone M. Hallquist, M.D. 6565 South Yale Avenue Ste 912 urological surgery TulsaTulsa, OK 7413-6
Excl. Body Parts/Svcs:Contact: Carolyn all except specialty (sees
specialty only)Phone: (918) 494-9440 Fax: (918) 494-9473
American Board of UrologyT R MITF
* Physician has multiple specialties.