OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS Date: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 08:27 (Alphabetical by Specialty) Page: 1 As of July 1, 2017 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts Tulsa Tulsa, OK74132-1823 [email protected]Excl. Body Parts/Svcs: Contact: Jan None Phone: (918) 513-3226 Fax: (918) 447-9308 American Board of Anesthesiology T Anesthesiology Emad Attallah-Wasif, M.D. 10124 S Sheridan Rd Suite B pain management Tulsa Tulsa, OK74133 [email protected]Contact: Scheduling Dept. Phone: (918) 986-7533 Fax: ( ) - American Board of Anesthesiology T R MITF Anesthesiology Blake Christensen, D.O. PO 514 All, intervential pain management Oklahoma City Norman, OK73070 [email protected]Contact: Cindy Smiley Phone: (405) 286-9820 Fax: ( ) - Certification Unknown T R MITF Anesthesiology Frank J. Hackl, M.D. 7901 S Sheridan Pain Management Tulsa Tulsa, OK74133 Contact: Phone: (918) 710-4112 Fax: (918) 710-4118 American Board of Anesthesiology - Pain Medicine T * Physician has multiple specialties.
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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 1
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts TulsaTulsa, OK74132-1823
[email protected] Excl. Body Parts/Svcs:Contact: Jan NonePhone: (918) 513-3226 Fax: (918) 447-9308
American Board of AnesthesiologyT
Anesthesiology Emad Attallah-Wasif, M.D. 10124 S Sheridan Rd Suite B pain management TulsaTulsa, OK74133
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 2
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management TulsaTulsa, OK74137
[email protected] Excl. Body Parts/Svcs:Contact: Brenda all except pain management casesPhone: (918) 477-5943 Fax: ( ) -
American Osteopathic Board ofAnesthesiology & Pain Management
T
Anesthesiology Daniel G. Morris, D.O.* 4110 S 100th East Ave Suite 201 Pain Management Only TulsaTulsa, OK74146
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 3
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Terrell R. Phillips, D.O. 401 SW 80 Street Ste 200 Pain Management Oklahoma CityOklahoma City, OK73139
[email protected] Excl. Body Parts/Svcs:Contact: Tammy none within specialtyPhone: (405) 601-4227 Fax: (405) 601-4237
American Osteopathic Board ofAnesthesiology
T R MITF
Anesthesiology Brian Torgerson, M.D. 6802 S. Olympia Ave Suite 100 pain management TulsaTulsa, OK74132
Contact: AlannaPhone: (918) 513-3228 Fax: ( ) -
Anesthesiology and Pain ManagementT
Anesthesiology Adam J. Wallace, M.D. 6802 S Olympia Ave Ste 100 pain management TulsaTulsa, OK74132
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 4
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Anesthesiology Traci L. White, M.D. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK73132-1923
Chiropractic Michael A. Chiaffitelli, D.C. 10001 S Penn Bldg P Ste 170 all chiropractics - spine Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Alisha all but spinePhone: (405) 681-2273 Fax: (405) 681-2274
Certification UnknownT
Chiropractic Seyoung Kim, D.C. 3435 NW 50th St. spine (neck, back), hand Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Kristin or Angie NonePhone: (405) 942-4040 Fax: (405) 773-4267
Certification UnknownT
Chiropractic C. Keith Muse, D.C. 6825 S Western Ave neuromusculoskeletal Oklahoma CityOklahoma City, OK73139
Excl. Body Parts/Svcs:Contact: Peggy NonePhone: (405) 634-1127 Fax: (405) 634-1177
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 5
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Jim R. Muse, D.C. 6825 S Western Spine, Extermities Oklahoma CityOklahoma City, OK73139
and throatPhone: (580) 256-1555 Fax: (580) 256-3370
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 6
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Chiropractic Steve Sweeney, D.C. 211 S. Sooner Rd. Spine, upper and lower extremities Midwest CityMidwest City, OK73110
[email protected] Excl. Body Parts/Svcs:Contact: Misty Cardiovascular, Pulmonary,
Dentistry Steven W. Hogg, D.D.S. 423 W Washington St mouth, teeth, jaw Broken ArrowBroken Arrow, OK74012
[email protected] Excl. Body Parts/Svcs:Contact: Mary NonePhone: (918) 455-8899 Fax: (918) 362-9997
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 7
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine Ken Bowlware, D.O. 14024 Quail Pointe Dr. all OKCOklahoma City, OK73134
Family Medicine Jason M. Leinen, M.D.* 3110 SW 89th Suite 102 all family & sports medicine, pain Oklahoma Citymanagement (evaluate all bodyOklahoma City, OK73159parts)[email protected]
Contact: AmyExcl. Body Parts/Svcs:Phone: (405) 703-3611 Fax: (405) 703-3711none
American Board of Family MedicineT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 8
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Medicine Steve Randall, M.D. 3400 S Douglas Blvd Suite 302 Interventional Pain Management Oklahoma CityOklahoma City, OK73150
American Osteopathic Board ofAnesthesiology-Pain Management
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 9
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Family Practice Lance E. Rosson, D.O. 1211 N Shartel Ste 1104 all Oklahoma CityOklahoma City, OK73103
Hand Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: Aliceall 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 Carolyn Berg, MD 9709 E 79th Street South Hands, Wrists, Forearm TulsaTulsa, OK74133
Excl. Body Parts/Svcs:Contact: Pam all but listedPhone: (918) 994-4000 Fax: ( ) -
American Board of SurgeryT R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 10
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery James F. Bischoff, M.D.* 2448 East 81st Street Suite 1520 hands, wrists TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: spine, elbows, shoulders, feet,
Hand Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 Shoulder, Elbow, Hand, Wrist TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae Knee, Ankle, Hip, Spine, Neck,
PelvisPhone: (918) 582-6800 Fax: (918) 301-4293
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: eRNESTall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 11
As of July 1, 2017
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
Hand Surgery Daron C. Hitt, M.D. 3115 SW 89 Street hands only Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 424-5630 Fax: (405) 692-1632
American Board of SurgeryT R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 12
As of July 1, 2017
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
Hand Surgery Stephen W. Mihalsky, M.D. 105 S Bryant Ste 407 Hand Surgery- Elbow, Wrist, Hand Midwest City,EdmondEdmond, OK73034
[email protected] Excl. Body Parts/Svcs:Contact: Judith Palmer Neck and ShoulderPhone: (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. 4802 S. 109th E. Ave. fingers to elbows TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Latoya Everything except Hand and WristPhone: (918) 392-1400 Fax: (918) 392-1401
American Board of Surgery - HandSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 13
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery M. Sean O'Brien, D.O.* 3110 SW 89th St., Suite 200C Hands and Shoulders Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Marilyn back, neck, feetPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
Hand Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand, arm Oklahoma CityOklahoma City, OK73112-4418
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 (spine), feetPhone: (405) 947-0911 Fax: (405) 947-4263
American Board of OrthopedicSurgery, Hand Surgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 14
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Hand Surgery Houshang Seradge, M.D.* 1044 SW 44 Street Suite 518 hands & wrists Oklahoma CityOklahoma City, OK73109
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 15
As of July 1, 2017
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 Internal Medicine-All body parts TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda Pulmonary and Chemical exposure,
including moldPhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
Neurology Gabriel Pitman, D.O. 401 SW 80 STE 201 Neurology-Head and Spine, Oklahoma Cityperipheral nerveOklahoma City, OK73139
Neuropsychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126
American Board of ProfessionalPsychology/Clinical Neuropsych
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 16
As of July 1, 2017
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 NeuropsychologyT R
Neuropsychology - Clinical Russell Pella, PhD 7146 S Braden Ave Suite 500 clinical neuropsychology TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: scheduler all but neuropsychology and
Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 17
As of July 1, 2017
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 Brain; Back (Spine); Chronic pain Lawtonissues multiple sitesLawton, OK73505
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 18
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neuropsychology Adam G. Sherman, Ph.D. 3015 E Skelly Dr Ste 135 all within specialty TulsaTulsa, OK74105
[email protected] Excl. Body Parts/Svcs:Contact: Susan NonePhone: (918) 712-2885 Fax: (918) 712-9019
Certification UnknownT R
Neurosurgery Clinton J. Baird, M.D. 6802 S Olympia Ave Ste 350 spine, brain, nerves, carpal Tulsatunnel, ulnar nerve, neurosurgeryTulsa, OK74132Excl. Body Parts/Svcs:Contact: Sheilahips, knees, jointsPhone: (918) 749-0762 Fax: (918) 744-4246
Certification UnknownT R
Neurosurgery Daniel Boedeker, M.D. 6767 S Yale Ave Ste A brain, spine, peripheral nerve for Tulsacarpal tunnelTulsa, OK74136
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 19
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Christopher G. Covington, M.D. Attn: Sheila Harless spine, brain, carpel tunnel Tulsa6802 S Olympia Ave Ste 300
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 20
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Emily D. Friedman, M.D. 3435 NW 56 Bldg A Ste 210 brain, spine, neck, carpal tunnel Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Dana all body parts not specifiedPhone: (405) 945-4900 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
[email protected] Excl. Body Parts/Svcs:Contact: Kelsey spine, shoulders, knees, lower
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 21
As of July 1, 2017
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), wrist (carpal Oklahoma Citytunnel)Oklahoma City, OK73120
Neurosurgery Brent N. Hisey, M.D. 14100 Parkway Commons Dr Ste 201 spine (neck, back), brain, carpal Oklahoma CitytunnelOklahoma City, OK73134
[email protected]. Body Parts/Svcs:Contact: AlishaNothing outside of cervical,Phone: (405) 242-4720 Fax: (405) 242-4933lumbar, and brain
American Board of NeurologicalSurgery
T R MITF
Neurosurgery Donald D. Horton, M.D. 14100 Parkway Commons Dr Ste 201 spinal surgery (cervical/lumbar) Oklahoma Citycarpal tunnelOklahoma City, OK73134
[email protected]. Body Parts/Svcs:Contact: Marie, AlishaNothing outside of cervical,Phone: (405) 242-4720 Fax: (405) 242-4765lumbar, brain or carpal tunnel
American Board of NeurologicalSurgery
T R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 22
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Kyle Mangels, M.D. 6802 S Olympia Ave Ste 300 neurological surgery spine, brain, Tulsacarpal tunnel. ulnar nerveTulsa, OK74132
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 23
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Stan Pelofsky, M.D. 4120 W Memorial Rd Ste 300 Head, Neck, Back, Wrist (Carpal Oklahoma CityTunnel)Oklahoma City, OK73120
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 24
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery W. Emery Reynolds, M.D. 4120 W Memorial Ste 208 head, spine Oklahoma CityOklahoma City, OK73120
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 25
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Neurosurgery Caple A Spence, M.D. 8121 National Ave Ste 210 brain, spine, peripheral nerves MWCMidwest City, OK73110
[email protected] Excl. Body Parts/Svcs:Contact: Christy all except brain, spine, peripheral
nervesPhone: (405) 455-3393 Fax: (405) 455-7162
American Board of NeurologicalSurgery
T
Neurosurgery Robert E. Tibbs, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists (carpal tunnel) Oklahoma CityOklahoma City, OK73120
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 26
As of July 1, 2017
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 head, neck, back, wrist (carpal Oklahoma Citytunnel)Oklahoma City, OK73120
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 27
As of July 1, 2017
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
[email protected] Excl. Body Parts/Svcs:Contact: Sharon or Sandy nonePhone: (918) 481-0994 Fax: (918) 494-6747
American Board of Internal Medicine& Preventive Medicine
T R MITF
Occupational Medicine John W. Hallford, D.O. 5682 W Skelly Dr occupational medicine/General TulsaPracticeTulsa, OK74107
[email protected]. Body Parts/Svcs:Contact: Erin or ChristinanonePhone: (918) 446-1891 Fax: (918) 446-1894
American Osteopathic Board ofFamily Physicians
T R MITF
Occupational Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 28
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine William D. Jones, M.D. 707 NW 13 St all occupational medicine (rating Oklahoma Cityonly)Oklahoma City, OK73103
Occupational Medicine Robert Paul, M.D. 6717 S Yale Ave Suite 107 all within specialty TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Linda PsychiatricPhone: (918) 496-1991 Fax: ( ) -
Certification Unknown R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 29
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine Carl B. Pettigrew, D.O. 1211 N Shartel Ste 500 all Oklahoma City,TulsaOklahoma City, OK73103
Occupational Medicine J. A. Snelling, D.O. PO Box 702738 Spine, Musculoskeletal TulsaTulsa, OK74170
none Excl. Body Parts/Svcs:Contact: Margaret Cardiac-RespiratoryPhone: (918) 749-3187 Fax: (918) 491-9925
American Board of FamilyPhysicians, Am Board of PreventiveMed.
R
Occupational Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St Internal Medicine-All body parts TulsaTulsa, OK74107
Excl. Body Parts/Svcs:Contact: Rhonda Pulmonary and Chemical exposure,
including moldPhone: (918) 742-4881 Fax: (918) 742-5854
Internal MedicineT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 30
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Occupational Medicine Mark Stephen Wilson, M.D.* 2821 NW 50th Street all orthopedics, continuing medical Tulsa, OKCmaintenanceOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-TaylerNonePhone: (405) 606-6886 Fax: (405) 606-6544
Certification UnknownT R MITF
Orthopedic Surgery Kasra Ahmadinia, M.D. 6475 S. Yale Ave Suite 301 Spine - back and neck TulsaTulsa, OK74136
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 31
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery John W. Anderson, M.D. 3301 NW 50 St foot and ankle Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck, back) and upper
Orthopedic Surgery Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566
[email protected] Excl. Body Parts/Svcs:Contact: Pam All except brain, neck, spinePhone: (918) 994-4068 Fax: (918) 994-4095
Certification UnknownT R
Orthopedic Surgery Jaafar M. Bazih, M.D. 4802 S 109 E Ave extremities, hands TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Denise spine: back & neckPhone: (918) 392-1400 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 32
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery James F. Bischoff, M.D.* 2448 East 81st Street Suite 1520 hands, wrists TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: spine, elbows, shoulders, feet,
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 33
As of July 1, 2017
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
rate only casesPhone: (918) 494-9300 Fax: (918) 494-9397
American Board of OrthopedicSurgery/Sports Medicine
T R
Orthopedic Surgery R. Tyler Boone, M.D. 6475 S Yale Ave Ste 301 neck, back TulsaTulsa, OK74136-7824
[email protected] Excl. Body Parts/Svcs:Contact: Lori hands, hips, knees, feet, ankles
shoulders, elbows, no rate only casPhone: (918) 494-9300 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, Shoulders, Hips, and Elbows Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling Spine (neck and back)Phone: (405) 947-0911 Fax: ( ) -
Certification UnknownT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 34
As of July 1, 2017
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
[email protected] Excl. Body Parts/Svcs:Contact: Lori hands, spine, feet, ankles,
shoulders, elbows, no rate onlyPhone: (918) 494-9300 Fax: (918) 494-9397cases
American Board of OrthopedicSurgery
T R
Orthopedic Surgery James D. Cash, M.D.* 2448 East 81st Street, Suite 1520 knees, shoulders TulsaTulsa, OK74137
Orthopedic Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 Shoulder, Elbow, Hand, Wrist TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae Knee, Ankle, Hip, Spine, Neck,
PelvisPhone: (918) 582-6800 Fax: (918) 301-4293
American Osteopathic Board ofOrthopedic Surgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 35
As of July 1, 2017
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
[email protected] Excl. Body Parts/Svcs:Contact: Brooke all except foot & anklePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Ashley Cogar, M.D. 9800 Broadway Extension Suite 201 elbow, wrist, hand Oklahoma CityOklahoma City, OK73114
[email protected] Excl. Body Parts/Svcs:Contact: Diana, Jennifer spine, shoulder, hip, knee, ankle
or footPhone: (405) 419-5665 Fax: (405) 419-5429
Certification UnknownT R
Orthopedic Surgery Arthur Hobart Conley, III, M.D. P O Box 891328 (spine) back and neck only Oklahoma CityOklahoma City, OK73189
[email protected] Excl. Body Parts/Svcs:Contact: Sarita all except spinePhone: (405) 703-7306 Fax: (405) 703-7334
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 36
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Jimmy Harold Conway, M.D. 10001 S Western Ste 101 elbows, knees Oklahoma CityOklahoma City, OK73139-2997
Orthopedic Surgery Thomas G. Craven, M.D. 6585 S Yale Ste 200 spine (neck, back) TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Melissa, Linda hands, wrists, knees, anklesPhone: (918) 481-2767 Fax: (918) 481-7669
American Board of OrthopedicSurgery
T R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 37
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Scott De La Garza, M.D. 608 NW 9 Street Ste 6000 spine only (lumbar, cervical, Oklahoma Citythorasic)Oklahoma City, OK73102
Orthopedic Surgery Kevin M. Dukes, M.D. 4802 S 109 E Ave shoulders TulsaTulsa, OK74146
Excl. Body Parts/Svcs:Contact: Denise all but shoulderPhone: (918) 392-1437 Fax: (918) 392-1401
American Board of OrthopedicSurgery
T
Orthopedic Surgery Ronald Matthew Dumigan, M.D. 1110 N Lee Knees, Shoulders, Elbows, ankles, Oklahoma City,Edmond, NormanOklahoma City, OK73103
[email protected] Excl. Body Parts/Svcs:Contact: Lori Spine, Neck, HipPhone: (405) 230-9270 Fax: (405) 230-9505
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 38
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Rory C. Dunham, D.O. 9060 Harmony Drive, Ste. B hand, knee, shoulder, ankle, elbow, Midwest Cityhip, feet, backMidwest City, OK73130
Orthopedic Surgery David J. Flesher, M.D. 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Central Scheduling AnklesPhone: (405) 947-0911 Fax: (405) 948-5177
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 39
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Thomas H. Flesher, III, M.D. 3301 NW 50 St shoulders, ankles, knees, hips Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: central scheduling spine (back, neck), wrists, handsPhone: (405) 947-0911 Fax: (405) 948-5171
American Board of OrthopedicSurgery
T
Orthopedic Surgery Winston Fong, M.D. 1110 N Lee spine only (cervical, thoracic, OKC, Edmondlumbar)Oklahoma City, OK73103
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 40
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Jeff A. Fox, M.D.* 6585 S Yale Ave Ste 200 knees, ankles, elbow, shoulders TulsaTulsa, OK74136
Orthopedic Surgery Sami R. Framjee, M.D. 2000 S Wheeling Ave Ste 1110 spine and general orthopaedics Tulsa (Treatonly) andTulsa, OK74104Oklahoma [email protected] Excl. Body Parts/Svcs:
Contact: Teri 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: eRNESTall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 41
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Charles H. Funderburk, M.D.* 1110 N Lee hands, shoulders, elbows, knees, Oklahoma Ctiy,wrists, forearm EdmondOklahoma City, OK73103-2612
Orthopedic Surgery Timothy Michael Geib, M.D. 13401 N Western Ave, Ste. 301 knees, shoulders, elbows, hips, Edmond, OKChands, armsOklahoma City, OK73114
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 42
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Greg Halko, M.D.* 3301 NW 50 hands, upper extremities Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) and lower
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 43
As of July 1, 2017
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
Excl. Body Parts/Svcs:Contact: Allison shoulders, elbows, hips, knees
Orthopedic Surgery Robert Frazer Hines, M.D. 9800 Broadway Extension Suite 201 shoulders, knees Oklahoma CityOklahoma City, OK73114
[email protected] Excl. Body Parts/Svcs:Contact: Naci Neck, back, foot and ankle, elbow,
hipPhone: (405) 348-6004 Fax: (405) 715-8853
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 44
As of July 1, 2017
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, knees, shoulders TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae Cheatham Back, NeckPhone: ( ) - 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
Orthopedic Surgery Christopher Shane Hume, D.O. 10001 S. Western Ave Suite 202 spine (neck & back) Oklahoma CityOklahoma City, OK73139
[email protected] Excl. Body Parts/Svcs:Contact: scheduler all except specialityPhone: (405) 427-3705 Fax: ( ) -
Board EligibleT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 45
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Antoine I. Jabbour, M.D. 4802 S 109 E Ave knees, shoulders TulsaTulsa, OK74146
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: Lori neck,backPhone: (405) 230-9270 Fax: (405) 230-9474
American Board of Family Medicine &Orthopaedic Surgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 46
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery J. Calvin Johnson, M.D. 9800 Broadway Extension Suite 203 knees, shoulders Oklahoma CityOklahoma City, OK73114
Orthopedic Surgery Daniel J. Jones, M.D. 8100 S Walker Ave Bldg A knee, shoulder, foot, ankle, legs, Oklahoma Cityarms, elbowsOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: Alice Mataspine and neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 47
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Michael E. Kiehn, M.D. 3301 NW 50 St knees, shoulders Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Jaye Dee Watts spine (neck, back)Phone: (405) 947-0911 Fax: (405) 942-5043
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hips, ankles, arms NormanNorman, OK73072
[email protected]. Body Parts/Svcs:Contact: BrookespinePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R
Orthopedic Surgery Zakary A. Knutson, M.D. 3400 W Tecumseh Ste 101 hips, knees, shoulders, elbows Norman, EdmondNorman, OK73072
[email protected] Excl. Body Parts/Svcs:Contact: Brooke foot, ankle, neck and backPhone: (405) 517-3719 Fax: ( ) -
Certification UnknownT R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 48
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Mark F. Kowalski, M.D. 4140 W Memorial Rd Ste 308 Shoulders, Arms, Elbows, Hands, Oklahoma CityHips, Legs, Knees, Ankles, and FeetOklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Laura Shelton, Diane EnglesNeck and BackPhone: (405) 749-7031 Fax: (405) 749-7036
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Sarat Kunapuli, D.O. 6475 S Yale Suite 301 Knees, Hips and Shoulders TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Lori all except listedPhone: (918) 494-9300 Fax: ( ) -
American Osteopathic AssociationT 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.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 49
As of July 1, 2017
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, foot TulsaTulsa, OK74136
Orthopedic Surgery Brian A. Levings, D.O. 8100 S Walker Ave Bldg A arms, legs, shoulders, knees, feet, Oklahoma Cityankles, elbowsOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: Alice Mataback, neckPhone: (405) 632-4468 Fax: (405) 632-4317
American Osteopathic Board ofOrthopaedic Surgery
T R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 50
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Alan G. Lewis, M.D. 2448 East 81st Street, Suite 1520 feet, ankles, knees TulsaTulsa, OK74137
Excl. Body Parts/Svcs:Contact: spine, hips, hands, elbows,
shoulders, rate only casesPhone: (918) 900-2520 Fax: (918) 900-2521
Premier Orthopedic Specialists ofTulsa
T R
Orthopedic Surgery J. Patrick Livingston, M.D. 1211 N Shartel Suite 500 orthopedic surgery, neck, back, Oklahoma Cityshoulders, hips, arms, legs, hands,Oklahoma City, OK73103feet
Orthopedic Surgery Jay D. Lorton, M.D. 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Lori spine, hands, hips, feetPhone: (918) 494-9300 Fax: (918) 494-9397
American Board of OrthopedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 51
As of July 1, 2017
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 Oklahoma CityOklahoma City, OK73159
Orthopedic Surgery Robert Marsh, D.O. 6475 S Yale Ave. Suite 301 all body parts but spine and neck TulsaTulsa, OK74136
Excl. Body Parts/Svcs:Contact: Wendy spine and neckPhone: (918) 494-9300 Fax: ( ) -
American Osteopathic AssociationT R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 52
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery James C. Mayoza, M.D. 6122 E 61 St Orthopedic surgery all body parts TulsaTulsa, OK74136-2117
Contact: Nicci or MorgiePhone: (918) 492-3133 Fax: (918) 493-2215
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery Yogesh Mittal, M.D. 1809 E 13 St Ste 100 Orthopedic Surgeon-Total Joint- TulsaKnees-HipsTulsa, OK74104Excl. Body Parts/Svcs:Contact: Nancy 918-925-3204spinePhone: (918) 582-6800 Fax: (918) 301-4293
American Board of OrthopaedicSurgery
T
Orthopedic Surgery Mac E. Moore, M.D. 10001 S Western Ste 200 shoulders, elbows, knees Oklahoma CityOklahoma City, OK73139-2997
Excl. Body Parts/Svcs:Contact: Belinda nonePhone: (405) 692-3737 Fax: (405) 692-3707
American Board of OrthopaedicSurgery
T R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 53
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Jeffrey R. Morris, D.O.* 6585 S. Yale Ave Suite 200 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74136
Orthopedic Surgery Ryan L. Nelson, D.O 1616 S. Kelly Orthopedic Surgery (Shoulder, EdmondElsbow, Knee, Trauma/Fractures Hip,Edmond, OK73013Wrist, Ankle)[email protected]
Contact: SchedulerExcl. Body Parts/Svcs:Phone: (405) 330-8847 Fax: ( ) -none
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 54
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery David E. Nonweiler, M.D. 6585 S Yale Ave Ste 200 shoulders, knees TulsaTulsa, OK74136
[email protected] Excl. Body Parts/Svcs:Contact: Melissa neck, spine, hips, hands and wristsPhone: (918) 481-2767 Fax: (918) 481-7611
American Board of OrthopedicSurgery
T R MITF
Orthopedic Surgery M. Sean O'Brien, D.O.* 3110 SW 89th St., Suite 200C Hands and Shoulders Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Marilyn back, neck, feetPhone: (405) 759-2663 Fax: ( ) -
American Osteopathic Board ofOrthopedic Surgery
T
Orthopedic Surgery James M. Odor, M.D. 14100 Parkway Commons Dr Ste 200 Spine surgery (Neck and entire Oklahoma CitySpine)Oklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Valerie, ReneeAmything NOT connected with thePhone: (405) 242-4345 Fax: (405) 242-4333spine (neck and back)
American Board of OrthopedicSurgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 55
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery L. Todd Olsen, D.O. Olsen Orthopedics knees, shoulders MWC3400 S Douglas Blvd Ste 302Oklahoma City, OK73150 Excl. Body Parts/Svcs:
Orthopedic Surgery Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 Orthopedics; Sports Medicine TulsaTulsa, OK74104
[email protected] Excl. Body Parts/Svcs:Contact: Rae Back, Foot/ankle, handPhone: (918) 582-6800 Fax: ( ) -
American Osteopathic BoardT
Orthopedic Surgery Kris Parchuri, D.O. 9101 S Toledo Ave Ste B spine TulsaTulsa, OK74137
sostulsa.com Excl. Body Parts/Svcs:Contact: Sarah hands, feetPhone: (539) 664-4448 Fax: (539) 664-4288
AOAT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 56
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Andrew Parkinson, M.D. 3301 NW 50 St spine, (neck, back), lower Oklahoma CityextremitiesOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: central schedulingall except spine & lowerPhone: (405) 947-0911 Fax: ( ) -extremities
American Board of OrthopaedicSurgery
T R MITF
Orthopedic Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand, arm Oklahoma CityOklahoma City, OK73112-4418
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 57
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 shoulder, elbows, wrists, hips, Tulsaknees, ankles, neck spineTulsa, OK74136
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 58
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Blake Shockley, M.D. 6585 S Yale Ave Suite 200 shoulder, elbow, hip, knee and Tulsa areaankleTulsa, OK74136
Orthopedic Surgery Glenn L. Smith, D.O. 2149 SW 59 Ste 101 all orthopedic surgery Oklahoma CityOklahoma City, OK73119
[email protected] Excl. Body Parts/Svcs:Contact: Linda FeetPhone: (405) 682-4651 Fax: (405) 682-3391
Orthopedic SurgeryT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 59
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Sheryl C. Smith, M.D. 9800 Broadway Extension Suite 201 foot, ankle Oklahoma CityOklahoma City, OK73114
[email protected] Excl. Body Parts/Svcs:Contact: Kim all except foot & anklePhone: (405) 419-5610 Fax: (405) 419-5429
Certification UnknownT R
Orthopedic Surgery Cheng-Lun Soo, M.D. 1044 SW 44 Street spine, neck, lumbar, cervical Oklahoma CityOklahoma City, OK73109
[email protected] Excl. Body Parts/Svcs:Contact: Ernest all except neck and backPhone: (405) 631-4263 Fax: (405) 631-1767
American Board of OrthopedicSurgery
T R
Orthopedic Surgery Wesley Michael Stotler, D.O. 4802 S 109 E Ave foot, ankle TulsaTulsa, OK74146
[email protected] Excl. Body Parts/Svcs:Contact: Denise all except feet and anklesPhone: (918) 392-1403 Fax: (918) 392-1401
American Osteopathic Board ofOrthopedic Surgery
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 60
As of July 1, 2017
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, wrist, elbows Oklahoma CityOklahoma City, OK73139
Orthopedic Surgery Mark Stephen Wilson, M.D.* 2821 NW 50th Street all orthopedics, continuing medical Tulsa, OKCmaintenanceOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-TaylerNonePhone: (405) 606-6886 Fax: (405) 606-6544
Certification UnknownT R MITF
Orthopedic Surgery David K. Wong, M.D. 6585 S Yale Ave Ste 200 hands, wrists, elbows, shoulders TulsaTulsa, OK74136
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 61
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedic Surgery Michael Wright, M.D. 3115 SW 89 Spine (evaluat all body parts) Oklahoma CityOklahoma City, OK73159
Excl. Body Parts/Svcs:Contact: Krista NonePhone: (405) 424-5630 Fax: (405) 692-1632
American Board of Spine SurgeryT R
Orthopedic Surgery Gregory J. Zeiders, D.O. 1800 S. Renaissance Blvd, Suite 210 hands, wrists, elbows, shoulders, Edmond,feet, ankles, knees, hips Oklahoma City,Edmond, OK73013
[email protected]. Body Parts/Svcs:Contact: LindsayspinePhone: (405) 509-7370 Fax: (405) 509-7373
American Osteopathic Board ofOrthopedic Surgery
T R
Orthopedics Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 Sports Medicine, Food and Ankle TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: Rae spine, handPhone: (918) 582-6800 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 62
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedics Joel M. Davis, M.D. 3301 NW 50 Street lower extremities, feet, ankles OKCOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: central scheduling Spine (neck, back)Phone: (405) 947-0911 Fax: (405) 947-1341
Certification UnknownT R MITF
Orthopedics William Bentley Edmonds, M.D. 1110 N Lee foot, ankle Oklahoma City,Edmond, NormanOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: Lori all except foot and anklePhone: (405) 230-9270 Fax: (405) 230-9424
American Board of OrthopaedicSurgery
T R
Orthopedics David Holden, M.D. 1110 N Lee knees & shoulders only Oklahoma City,NormanOklahoma City, OK73103-2612
[email protected] Excl. Body Parts/Svcs:Contact: Lori Spine, Neck, Hip, Ankles, Feet,
ElbowsPhone: (405) 230-9270 Fax: ( ) -
American Board of OrthopaedicSurgery & Sports Medicine
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 63
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Orthopedics Michael Brandon Johnson, M.D. 9800 Broadway Extension Suite 203 all within specialty OKCOklahoma City, OK73114
Excl. Body Parts/Svcs:Contact: Debra Lewis SpinePhone: (405) 424-5417 Fax: (405) 424-5418
Certification UnknownT
Orthopedics Faustino Kazenske, D.O. 3301 NW 50th Street Lower extremities, hips, knees Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Central Scheduling Upper extremities and backPhone: (405) 947-0911 Fax: ( ) -
Certification UnknownT R MITF
Orthopedics Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hips, ankles, arms NormanNorman, OK73072
[email protected]. Body Parts/Svcs:Contact: BrookespinePhone: (405) 517-3719 Fax: (405) 360-6769
American Board of OrthopaedicSurgery
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 64
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Otolaryngology R. Stanley Baker, M.D. 3400 NW 56 St ears Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Dawn all other than earsPhone: (405) 946-5563 Fax: ( ) -
American Board of OtolaryngologyT R
Otolaryngology Alen Munson Fuller, M.D. 1725 E 19 St Ste 100 Ears, Nose, Throat, Hearing- TulsaCummulative Noise ExposureTulsa, OK74104
Otolaryngology John R. Houck, M.D. 800 Stanton L Young AAT 1400 ear, nose, throat OKCOklahoma City, OK73104
[email protected] Excl. Body Parts/Svcs:Contact: Tiffney tiffaney-cardwell@ouhs complaints of dizziness or hearing
lossPhone: (405) 271-1368 Fax: (405) 271-3248
American Board of OtolaryngologyT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 65
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Otology Mark Wood, M.D. 3400 NW 56 St ears, hearing, including dizziness Oklahoma CityOklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Valoree anything other than earsPhone: (405) 946-5563 Fax: (405) 945-7185
American Board of OtolaryngologyT R
Physical Medicine and Donald E. Adams, M.D. 1616 S Kelly pain management EdmondRehabilitation Edmond, OK73013-3651
American Board of Medicine &Rehabilitation & Pain Medicine
T R
Physical Medicine and Archana Barve, M.D. 3613 NW 56 STREET STE 140 sports medicine, physical medicine Oklahoma CityRehabilitation & rehabilitationOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: Staceyspinal cord injury with paraplegia,Phone: (405) 949-6481 Fax: (405) 795-5909quadriplegia
American Board of PhysicalMedicine/Rehabilitation
T
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 66
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Physical Medicine and Albert J. Bisson, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, spine, upper and Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120
Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic mngmt, rsd
American Board of PhysicalMedicine/Rehabilitation
T R
Physical Medicine and Michael S. Brown, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, neck, spine Oklahoma CityRehabilitation upper and lower extremities, nerveOklahoma City, OK73120
American Board of Physical Medicineand Rehab-Pain Management
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 67
As of July 1, 2017
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
Excl. Body Parts/Svcs:Phone: (918) 481-2767 Fax: (918) 481-7669none
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 chronic Oklahoma CityRehabilitation medication management, continuingOklahoma City, OK73102
medical [email protected]: SarahPhone: (405) 601-5899 Fax: (405) 601-5903
American Board of Physical Medicineand Rehabilitation
T
Physical Medicine and D. Brent Tipton, M.D. 5100 N Brookline Ste 530 muscles and nerves Oklahoma CityRehabilitation Oklahoma City, OK73112
[email protected] Excl. Body Parts/Svcs:Contact: Leti Ramirez heart, lungs, GI, Renal, medical
American Board of PhysicalMedicine/Rehabilitation/Electrodiagnos
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 68
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Plastic Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139
[email protected]. Body Parts/Svcs:Contact: Aliceall 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
Podiatry Armando A. Carro, D.P.M. 600 W 15 St foot, ankle Edmond andShawneeEdmond, OK73013
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 69
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Podiatry Timothy Siegfried, D.P.M. 10229 E 96 Street North Ste 100 foot, ankle OwassoOwasso, OK74055
[email protected] Excl. Body Parts/Svcs:Contact: Melissa none within specialtyPhone: (918) 494-2902 Fax: (918) 272-8922
American Board of Podiatric SurgeryT R MITF
Podiatry William K. Smith, D.P.M. 1627 N Kickapoo Foot and Ankle Shawnee,Oklahoma CityShawnee, OK74804
Podiatry Richard J Traczyk, II, D.P.M. 4205 McAuley Blvd Ste 465 foot, ankle Oklahoma CityOklahoma City, OK73120
[email protected] Excl. Body Parts/Svcs:Contact: Lanae anything above the ankle and ankle
surgeryPhone: (405) 755-7600 Fax: (405) 755-7680
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 70
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychiatry Willis Holloway, M.D. 6613 N Meridian Ave psychiatry Oklahoma CityOklahoma City, OK73116
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 71
As of July 1, 2017
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
Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:none
Certification UnknownT R MITF
Psychology - Clinical Douglas O. Brady, Ph.D.* 1401 SW Park Ridge Blvd Ste D Brain; Back (Spine); Chronic pain Lawtonissues multiple sitesLawton, OK73505
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 72
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
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: Virginia GreenNonePhone: (405) 842-6446 Fax: (405) 842-5644
Certification UnknownT
Psychology - Clinical David E. Johnsen, Ph.D. 2601 NW Expway Ste 410 W Neuropsychology, Psychology, Oklahoma CityChronic PainOklahoma City, OK73112
[email protected]. Body Parts/Svcs:Contact: Sarah Baskervillehead/brain, psychological overlay,Phone: (405) 755-8576 Fax: (405) 755-6026pain management, trauma
Certification UnknownT R
Psychology - Clinical Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082
[email protected]. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021
Certification UnknownT R MITF
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 73
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 74
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Psychology Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082
[email protected]. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021
Certification UnknownT R MITF
Pulmonary Diseases Dennis M. Parker, M.D. 3366 NW Expressway Ste 660 pulmonary (lungs) Oklahoma CityOklahoma City, OK73112
Excl. Body Parts/Svcs:Contact: Lisa Burgess 405-947-3345 all except respiratory diseasePhone: (405) 917-5439 Fax: (405) 949-0849
American Board of InternalMedicine, Am Bd - Pulmonary Disease
T
Sports Medicine Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 75
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566
[email protected] Excl. Body Parts/Svcs:Contact: Pam All except brain, neck, spinePhone: (918) 994-4068 Fax: (918) 994-4095
Certification UnknownT R
Sports Medicine Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 Sports Medicine, Food and Ankle TulsaTulsa, OK74104
Excl. Body Parts/Svcs:Contact: Rae spine, handPhone: (918) 582-6800 Fax: (918) 582-6060
American Board of OrthopaedicSurgery
T R
Sports Medicine Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824
rate only casesPhone: (918) 494-9300 Fax: (918) 494-9397
American Board of OrthopedicSurgery/Sports Medicine
T R
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 76
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine James D. Cash, M.D.* 2448 East 81st Street, Suite 1520 knees, shoulders TulsaTulsa, OK74137
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 77
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Bryan Hawkins, M.D.* 6585 S Yale Ave Ste 200 ankles, knees, feet, hip TulsaTulsa, OK74136
Sports Medicine Jason M. Leinen, M.D.* 3110 SW 89th Suite 102 all family & sports medicine, pain Oklahoma Citymanagement (evaluate all bodyOklahoma City, OK73159parts)[email protected]
Contact: AmyExcl. Body Parts/Svcs:Phone: (405) 703-3611 Fax: (405) 703-3711none
American Board of Family MedicineT
* Physician has multiple specialties.
OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 08/01/2017 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:27 (Alphabetical by Specialty) Page: 78
As of July 1, 2017
Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified
Sports Medicine Jeffrey R. Morris, D.O.* 6585 S. Yale Ave Suite 200 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74136