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Date: 01/19/2017 Time: 08:45 OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS R...
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Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 1

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Anesthesiology

C. Scott Anthony, D.O.

6802 S Olympia Ave Ste 100 Tulsa, OK74132-1823

pain management - all body parts

[email protected] Contact: Jan Phone: (918) 513-3226 Fax: (918) 447-9308

City of Exam

Tulsa

Excl. Body Parts/Svcs: None American Board of Anesthesiology T

Anesthesiology

Emad Attallah-Wasif, M.D. Contact: Christina Phone: (918) 935-3240 Fax: ( )

2811 E 15th Street Suite 102 Tulsa, OK74104

pain management

Tulsa

American Board of Anesthesiology T

Anesthesiology

Blake Christensen, D.O.

Contact: Jeniffer Phone: (405) 286-9820 Fax: ( )

14100 Parkway Commons Dr Suite 100 Oklahoma City, OK73134

All, intervential pain management

Oklahoma City

Excl. Body Parts/Svcs: Heart, Kidneys, Liver, Lungs, GI Certification Unknown T R MITF

Anesthesiology

Frank J. Hackl, M.D.

7901 S Sheridan Tulsa, OK74133

Pain Management

Contact: Phone: (918) 710-4112 Fax: (918) 710-4118 American Board of Anesthesiology Pain Medicine T

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 2

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Anesthesiology

Gerald R. Hale, D.O.

2448 E 81 Ste 363 Tulsa, OK74137

pain management

[email protected] Contact: Brenda Phone: (918) 477-5943 Fax: ( )

City of Exam

Tulsa

Excl. Body Parts/Svcs: all except pain management cases American Osteopathic Board of Anesthesiology & Pain Management T

Anesthesiology

Daniel G. Morris, D.O.*

4110 S 100th East Ave Suite 201 Tulsa, OK74146

Pain Management Only

Tulsa

Contact: scheduling Phone: (918) 857-7246 Fax: (918) 359-5828 American Osteopathic Board of Anesthesiology-Pain Management T Anesthesiology

Jayen H. Patel, M.D. [email protected] Contact: appt desk Phone: (918) 935-3240 Fax: (918) 935-3241

2811 E 15 Street Ste 102 Tulsa, OK 7410-4

pain management, neck, back, extremities, nervous system, headache, joints, fractures Excl. Body Parts/Svcs: PTSD, psychological trauma American Board of Anesthesiology T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 3

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Anesthesiology

Terrell R. Phillips, D.O.

401 SW 80 Street Ste 200 Oklahoma City, OK73139

Pain Management

[email protected] Contact: Tammy Phone: (405) 601-4227 Fax: (405) 601-4237

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: none within specialty American Osteopathic Board of Anesthesiology T R MITF

Anesthesiology

Justin Porter, M.D.

3601 NW 138 Street Ste 200 Oklahoma City, OK73134

[email protected] Contact: Neile Phone: (405) 242-4100 Fax: (405) 775-9356

Pain Management - head, neck,back

Oklahoma City

Excl. Body Parts/Svcs: pelvic pain, vaginal pain, rectal pain Certification Unknown T

Anesthesiology

Adam J. Wallace, M.D. [email protected] Contact: Angelia, Julie Phone: (918) 447-9300 Fax: (918) 447-9308

6802 S Olympia Ave Ste 100 Tulsa, OK74132

pain management

Tulsa

Excl. Body Parts/Svcs: none Certification Unknown T

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 4

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Anesthesiology

Kalvin L. White, D.O.

6802 S Olympia Avenue Ste 100 Tulsa, OK74132-1823

Pain Management Only

City of Exam

Tulsa

[email protected] Contact: Angelia Phone: (918) 513-3231 Fax: (918) 447-9308 Am Board of Anesiology T Anesthesiology

Traci L. White, M.D.

6802 S Olympia Avenue Ste 100 Tulsa, OK73132-1923

Pain Management Only

Tulsa

Contact: Buffy Phone: (918) 513-3225 Fax: (918) 447-9308 American Board of Anesthesiology/Pain Medicine T Chiropractic

Michael A. Chiaffitelli, D.C.

10001 S Penn Bldg P Ste 170 Oklahoma City, OK73159

all chiropractics - spine

Oklahoma City

Excl. Body Parts/Svcs: all but spine

Contact: Alisha Phone: (405) 681-2273 Fax: (405) 681-2274

Certification Unknown T Chiropractic

Seyoung Kim, D.C. [email protected] Contact: Kristin or Angie Phone: (405) 942-4040 Fax: (405) 773-4267

3435 NW 50th St. Oklahoma City, OK73112

spine (neck, back), hand

Oklahoma City

Excl. Body Parts/Svcs: None Certification Unknown T

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 5

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Chiropractic

C. Keith Muse, D.C.

6825 S Western Ave Oklahoma City, OK73139

neuromusculoskeletal

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: None

Contact: Peggy Phone: (405) 634-1127 Fax: (405) 634-1177

Certification Unknown T R MITF Chiropractic

Jim R. Muse, D.C.

6825 S Western Oklahoma City, OK73139

Spine, Extermities

Oklahoma City

[email protected] Contact: Amber, Peggy Phone: (405) 634-1127 Fax: (405) 634-1177 Certification Unknown TR Chiropractic

James Daniel Post, D.C.

4141 NW Expressway Ste 180 Oklahoma City, OK73116

all chiropractics-spine

Oklahoma City

[email protected] Contact: Rhonda, Cathy Phone: (405) 840-8900 Fax: (405) 840-8990 Certification Unknown T

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 6

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Chiropractic

Troy A. Sturgill, D.C.

PO Box 335 Woodward, OK73802

musculoskeletal

[email protected] Contact: self Phone: (580) 256-1555 Fax: (580) 256-3370

City of Exam

Woodward

Excl. Body Parts/Svcs: internal orangs, brain, eyes, mouth and throat Certification Unknown T R MITF

Chiropractic

Steve Sweeney, D.C. [email protected] Contact: Misty Phone: (405) 672-4800 Fax: ( )

211 S. Sooner Rd. Midwest City, OK73110

Spine, upper and lower extremities

Midwest City

Excl. Body Parts/Svcs: Cardiovascular, Pulmonary, Digestive Hematopoietic

-

Certification Unknown TR Chiropractic

Ronald B. Tripp, D.C. [email protected] Contact: Sherri Phone: (405) 321-8530 Fax: (405) 321-1478

2400 Tee Circle Norman, OK73069

neck and back

Norman

Excl. Body Parts/Svcs: internal medicine Certification Unknown T R MITF

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 7

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Chiropractic

David B. Waggoner, D.C.

7000 NW Expressway Ste H Oklahoma City, OK73132

chiropractic

[email protected] Contact: Meaghan Phone: (405) 773-1113 Fax: ( )

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: non-musculoskeletal Certification Unknown T MITF

Dentistry

Steven W. Hogg, D.D.S.

423 W Washington St Broken Arrow, OK74012

[email protected] Contact: Mary Phone: (918) 455-8899 Fax: (918) 362-9997

mouth, teeth, jaw

Broken Arrow

Excl. Body Parts/Svcs: None Certification Unknown T R MITF

Dentistry

Sterling H. Stalder, D.D.S

930 SW 107 Street Oklahoma City, OK73170

[email protected] Contact: Renee/ Jenae Phone: (405) 634-7303 Fax: (405) 634-7868

mouth and teeth

Oklahoma City

Excl. Body Parts/Svcs: none Certification Unknown T

Family Medicine

Ken Bowlware, D.O.

Contact: Amy Phone: (405) 600-1411 Fax: ( )

14024 Quail Pointe Dr. Oklahoma City, OK73134

all Excl. Body Parts/Svcs: none

American Board of Family Medicine TR

* Physician has multiple specialties.

OKC

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 8

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Family Medicine

John Ellis, MD

5100 N Brookline Ave #465 Oklahoma City, OK73112

Occupational & Legal Medicine, Entire Body

[email protected] Contact: Kelly Phone: (405) 917-5336 Fax: ( )

City of Exam

OKC

Excl. Body Parts/Svcs: eyes

-

American Board of Family Medicine T R MITF Family Medicine

Jason M. Leinen, M.D.*

3115 SW 89 Street Oklahoma City, OK73159

[email protected] Contact: Amy Phone: (405) 600-1411 Fax: (405) 600-1531

all family & sports medicine, pain management (evaluate all body parts)

Oklahoma City

Excl. Body Parts/Svcs: none American Board of Family Medicine T

Family Medicine

Steve Randall, M.D. [email protected] Contact: Kendra Phone: (405) 733-8000 Fax: ( )

3400 S Douglas Blvd Suite 302 Oklahoma City, OK73150

Interventional Pain Management Excl. Body Parts/Svcs: Fibromyalgia

Intervential Pain Management and Family Medicine TR

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 9

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Family Medicine

Michael L. Winzenread, M.D.

105 S Bryant Ste 310 Edmond, OK73034

all

Contact: Kari Phone: (405) 757-5211 Fax: ( )

City of Exam

Edmond

Excl. Body Parts/Svcs: None American Board of Family Practice R MITF

Family Practice

Daniel G. Morris, D.O.*

4110 S 100th East Ave Suite 201 Tulsa, OK74146

Pain Management Only

Tulsa

Contact: scheduling Phone: (918) 857-7246 Fax: (918) 359-5828 American Osteopathic Board of Anesthesiology-Pain Management T Family Practice

Lance E. Rosson, D.O. NONE Contact: Sharon Phone: (405) 236-1900 Fax: (405) 236-0362

1211 N Shartel Ste 1104 Oklahoma City, OK73103

all Excl. Body Parts/Svcs: None American Board of Family Physicians T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 10

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

General Surgery

Russell L. Hanan, Jr., M.D.

608 NW 9 Ste 5010 Oklahoma City, OK73102

general surgery hernias, intestines, soft tissue

Oklahoma City

none Contact: Debbie Smith Phone: (405) 235-3245 Fax: (405) 235-6991

Excl. Body Parts/Svcs: head, neck, spine, pulmonary Certification Unknown T

Hand Surgery

Mehdi N. Adham, M.D.*

8100 S Walker Ave Bldg A Oklahoma City, OK73139

Contact: Alice Phone: (405) 632-4468 Fax: (405) 632-4317

plastic & reconstructive surgery of hands and wrists Excl. Body Parts/Svcs: all except plastic surgery of hands/wrists

Oklahoma City

American Board of Plastic Surgery & Am Bd Plastic Surg of Hand T R MITF Hand Surgery

Carolyn Berg, MD

Contact: Pam Phone: (918) 994-4000 Fax: ( )

9709 E 79th Street South Tulsa, OK74133

Hands, Wrists, Forearm

Tulsa

Excl. Body Parts/Svcs: all but listed American Board of Surgery TR

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 11

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

James F. Bischoff, M.D.*

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

hands, wrists

Tulsa

[email protected] Contact: Damita Carter 918-481-7658 Phone: (918) 494-9300 Fax: (918) 494-9397

Excl. Body Parts/Svcs: spine, elbows, shoulders, feet, ankles, knees, hips, rate only cases American Board of Orthopedic Surgery TR

Hand Surgery

Brian Chalkin, D.O.*

1809 E 13 St Ste 100 Tulsa, OK74104

[email protected] Contact: Rae Phone: (918) 582-6800 Fax: (918) 301-4293

Shoulder, Elbow, Hand, Wrist

Tulsa

Excl. Body Parts/Svcs: Knee, Ankle, Hip, Spine, Neck, Pelvis American Osteopathic Board of Orthopedic Surgery TR

Hand Surgery

Michael B. Clendenin, M.D. NONE Contact: Sheila Phone: (918) 749-1418 Fax: (918) 749-6241

2000 S Wheeling Ste 900 Tulsa, OK74104

hands and wrists only Excl. Body Parts/Svcs: all except hands and wrists American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 12

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

Tom W. Ewing, D.O.

1020 24 Ave NW Ste 100 Norman, OK73069

hands

Norman

[email protected] Contact: Melissa or Dana Phone: (405) 447-4999 Fax: (405) 447-5608

Excl. Body Parts/Svcs: all except hands American Osteopathic Board of Orthopedic Surgery TR

Hand Surgery

Joel L. Frazier, M.D.* Contact: eRNEST Phone: (405) 631-4263 Fax: ( )

1044 SW 44 St Ste 600 Oklahoma City, OK73109 -

hands, upper extremities, elbows, wrists Excl. Body Parts/Svcs: all except hands, elbows, wrists

Oklahoma City

American Board of Orthopedic Surgery TR Hand Surgery

Charles H. Funderburk, M.D.* [email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 522-9474

1110 N Lee Oklahoma City, OK73103-2612

hands, shoulders, elbows, knees, wrists, forearm Excl. Body Parts/Svcs: neck, back, hips, feet American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Oklahoma Ctiy, Edmond

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 13

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

Greg Halko, M.D.*

3301 NW 50 Oklahoma City, OK73112

hands, upper extremities

Oklahoma City

[email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: (405) 942-5043

Excl. Body Parts/Svcs: spine, (neck, back) and lower extremities American Board of Orthopedic Surgery T R MITF

Hand Surgery

Daron C. Hitt, M.D.

3115 SW 89 Street Oklahoma City, OK73159

hands only

Oklahoma City

Excl. Body Parts/Svcs: none

Contact: Amy Phone: (405) 424-5630 Fax: (405) 692-1632

American Board of Surgery TR Hand Surgery

Thomas C. Howard, M.D.* [email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9424

1110 N Lee Oklahoma City, OK73103-2612

hands, shoulders, knees, hips and feet Excl. Body Parts/Svcs: spine, (neck,back) American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Oklahoma City, Norman

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 14

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

Stephen W. Mihalsky, M.D.

105 S Bryant Ste 407 Edmond, OK73034

all within specialty

Midwest City, Edmond

Excl. Body Parts/Svcs: shoulders, neck

Contact: Donna Elswick Phone: (405) 348-5060 Fax: (405) 364-8750

American Board of Surgery of the Hand, American Board of Surgery TR Hand Surgery

David B. Mokhtee, M.D.

4802 S. 109th E. Ave. Tulsa, OK74146

fingers to elbows

Tulsa

Excl. Body Parts/Svcs: Everything except Hand and Wrist

Contact: Latoya Phone: (918) 392-1400 Fax: (918) 392-1401

American Board of Surgery - Hand Surgery T Hand Surgery

M. Sean O'Brien, D.O.*

Contact: Marilyn Phone: (405) 759-2663 Fax: ( )

3110 SW 89th St., Suite 200C Oklahoma City, OK73159

Hands and Shoulders Excl. Body Parts/Svcs: back, neck, feet

American Osteopathic Board of Orthopedic Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 15

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

Ghazi M. Rayan, M.D.*

3366 NW Expressway Ste 700 Oklahoma City, OK73112-4418

shoulder, elbow, wrist, hand

Oklahoma City

Excl. Body Parts/Svcs: back

Contact: Phone: (405) 945-4888 Fax: (405) 945-4887

American Board of Orthopedic Surgery/ Am Bd of Ortho Surg of Hand T R MITF Hand Surgery

Richard A. Ruffin, M.D.*

3301 NW 50 Oklahoma City, OK73112-5691

hands, wrists, elbows, shoulders

Oklahoma City

Excl. Body Parts/Svcs: neck & back (spine), feet, knees

Contact: Central Scheduling Phone: (405) 947-0911 Fax: (405) 947-4263

American Board of Orthopedic Surgery, Hand Surgery T Hand Surgery

Houshang Seradge, M.D.* Contact: Misti Phone: (405) 634-4263 Fax: ( )

1044 SW 44 Street Suite 518 Oklahoma City, OK73109

spine, foot, wrist, elbow, shoulder, hip, knee, ankle

American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 16

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Hand Surgery

Garrett Watts, M.D.

10507 E 91st Street Suite 350 Tulsa, OK74133

hands, wrists, elbows

Broken Arrow

[email protected] Contact: Central States Orthopedic Phone: (918) 451-3000 Fax: (918) 451-2700

Excl. Body Parts/Svcs: spine, neck, lower extremities American Board of Orthopedic Surgery T R MITF

Internal Medicine

S.A. Chaudry, M.D.

5611 Mosteller Dr Oklahoma City, OK73112

[email protected] Contact: Cheryl Phone: (405) 843-2345 Fax: (405) 843-8237

all internal medicine - whole body

Oklahoma City

Excl. Body Parts/Svcs: None American Board of Internal Medicine TR

Internal Medicine

Kent C. Hensley, M.D.*

9433 N Kelley Ave Oklahoma City, OK73131

NONE Contact: Yvonne, Leslie Phone: (405) 840-6720 Fax: (405) 840-6723

all

Oklahoma City

Excl. Body Parts/Svcs: psychiatric American Board of Internal Medicine R MITF

Internal Medicine

A. E. Moorad, M.D.*

4221 S Western Ste 3010 Oklahoma City, OK73109

all PM & R, pain managment

Contact: Marilyn Phone: (405) 636-7450 Fax: (405) 631-2296 American Board of Internal Medicine T R MITF * Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 17

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Internal Medicine

Kenneth R. Trinidad, D.O.*

1006 W 23 St Tulsa, OK74107

all

Tulsa

Excl. Body Parts/Svcs: Lungs

Contact: Rhonda Phone: (918) 742-4881 Fax: (918) 742-5854

Internal Medicine T R MITF Neurology

Gabriel Pitman, D.O. [email protected] Contact: Paula Byrd Phone: (405) 632-9090 Fax: ( )

401 SW 80 STE 201 Oklahoma City, OK73139

all within neurology specialty

Oklahoma City

Excl. Body Parts/Svcs: abdomen, chest American Board of Neurology T

Neurology

W. Dean Shipley, M.D. [email protected] Contact: Kelly Phone: (405) 302-2661 Fax: (405) 302-2670

4120 W Memorial Rd Ste 218 Oklahoma City, OK73120

nervous system only/adult nerology Excl. Body Parts/Svcs: neuological IME's only American Board of Psychiatry and Neurology T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

Specialty

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017 Physician/Contact Info

Neuropsychology - Clinical Russell L. Adams, Ph.D.*

Page: 18

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

PO Box 26901 WP3440 Oklahoma City, OK73126

brain, pain management, psychological overlay

Oklahoma City

Contact: Gary Phone: (405) 271-8001 Fax: (405) 271-8802 American Board of Professional Psychology/Clinical Neuropsych TR Neuropsychology - Clinical Michael R. Basso, Ph.D.* [email protected] Contact: Dr. Basso Phone: (918) 631-3151 Fax: (918) 631-2833

Univ of Tulsa Dept of Psychology 800 S Tucker Drive Tulsa, OK74104

head/brain - diatnostic testing, psychological overlay

Tulsa

Excl. Body Parts/Svcs: None ABPP - Clinical Neuropsychology R MITF

Neuropsychology

Faust Bianco, Jr., Ph.D.*

Contact: Suzan Phone: (918) 746-0794 Fax: (918) 746-0717

7146 S Braden Ave Ste 500 Tulsa, OK74136

Rehabilitation (nervous system, whole body) Trauma Related Disorders (pain stress, depression, brain) Excl. Body Parts/Svcs: none Certification Unknown T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 19

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neuropsychology

Douglas O. Brady, Ph.D.*

1401 SW Park Ridge Blvd Ste D Lawton, OK73505

Brain; Back (Spine); Chronic pain issues multiple sites

City of Exam

Lawton

[email protected] Contact: D'Ann Smith Phone: (580) 355-7474 Fax: (580) 355-6765 American Board of Professional Disability T R MITF Neuropsychology

David E. Hansen, Ph.D.

5512 S Lewis Ave Ste 8 Tulsa, OK74105

[email protected] Contact: Emge Phone: (918) 712-9004 Fax: (918) 712-9120

neuropsychology/brain

Tulsa

Excl. Body Parts/Svcs: None Certification Unknown R MITF

Neuropsychology

Terry G. Shaw, Ph.D. [email protected] Contact: Mary Phone: (918) 488-6165 Fax: (918) 488-8021

7146 S Braden Ste 500 Tulsa, OK74136

head, brain, psychological overlay Excl. Body Parts/Svcs: all excluded except parts listed as specialty American Board of Professional Neuropsychology TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 20

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neuropsychology

Adam G. Sherman, Ph.D.

3015 E Skelly Dr Ste 135 Tulsa, OK74105

all within specialty

[email protected] Contact: Susan Phone: (918) 712-2885 Fax: (918) 712-9019

City of Exam

Tulsa

Excl. Body Parts/Svcs: None Certification Unknown TR

Neurosurgery

Clinton J. Baird, M.D.

6802 S Olympia Ave Ste 350 Tulsa, OK74132

Contact: Sheila Phone: (918) 749-0762 Fax: (918) 744-4246

spine, brain, nerves, carpal tunnel, ulnar nerve, neurosurgery Excl. Body Parts/Svcs: hips, knees, joints

Tulsa

Certification Unknown TR Neurosurgery

Daniel Boedeker, M.D. [email protected] Contact: Kim Phone: (918) 491-3512 Fax: (918) 491-3542

6767 S Yale Ave Ste A Tulsa, OK74136

brain, spine, peripheral nerve for carpal tunnel Excl. Body Parts/Svcs: all except specialty Certification Unknown TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 21

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Christopher G. Covington, M.D.

Attn: Sheila Harless 6802 S Olympia Ave Ste 300 Tulsa, OK74132

spine, brain, carpel tunnel

[email protected] Contact: Sheila, Jamie Phone: (918) 749-0762 Fax: (918) 744-4246

City of Exam

Tulsa

Excl. Body Parts/Svcs: extremities American Board of Neurological Surgery T

Neurosurgery

Joseph Bridger Cox, M.D. [email protected] Contact: Ashley Phone: (405) 748-3300 Fax: ( )

4120 W. Memeorial Rd Oklahoma City, OK73120

Neck, Back, Wrist (carpal tunnel)

OKC

Excl. Body Parts/Svcs: Shoulders, Knees, lower extremities Certification Unknown T

Neurosurgery

Allan S. Fielding, M.D. [email protected] Contact: any staff member Phone: (918) 294-0080 Fax: ( )

2000 S Wheeling Ste 1110 Tulsa, OK74104

-

head, neck, back, shoulder, hip, knee, CTS, ulnar neuropathy Excl. Body Parts/Svcs: Neurosurgical Cases Only American Board of Neurological Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 22

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Emily D. Friedman, M.D.

3435 NW 56 Bldg A Ste 210 Oklahoma City, OK73112

brain, spine, neck, carpal tunnel

[email protected] Contact: Dana Phone: (405) 945-4900 Fax: (405) 945-4901

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: all body parts not specified American Board of Neurological Surgery T

Neurosurgery

Eric S. Friedman, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120-9322

[email protected] Contact: Kelsey Phone: (405) 748-3300 Fax: (405) 749-1671

brain and carpal tunnel only

Oklahoma City

Excl. Body Parts/Svcs: spine, shoulders, knees, lower extremities American Board of Neurological Surgery T

Neurosurgery

Steven E. Gaede, M.D. [email protected] Contact: Sheila,Melissa Phone: (918) 749-0762 Fax: (918) 744-4246

6802 S Olympia Ave Ste 300 Tulsa, OK74132

spine, brain, carpal tunnel, ulnar nerve Excl. Body Parts/Svcs: non-spine orthopedic cases American Board of Neurological Surgery T

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 23

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Michael Hahn, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

spine (neck, back), wrist (carpal tunnel)

[email protected] Contact: Tammy Phone: (405) 748-3300 Fax: (405) 749-1671

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: shoulders, knees, hips, elbows American Board of Neurological Surgery T

Neurosurgery

Brent N. Hisey, M.D.

14100 Parkway Commons Dr Ste 201 Oklahoma City, OK73134

[email protected] Contact: Alisha Phone: (405) 242-4720 Fax: (405) 242-4933

spine (neck, back), brain, carpal tunnel

Oklahoma City

Excl. Body Parts/Svcs: all except specialty American Board of Neurological Surgery T R MITF

Neurosurgery

Donald D. Horton, M.D. [email protected] Contact: Marie, Alisha Phone: (405) 242-4720 Fax: (405) 242-4765

14100 Parkway Commons Dr Ste 201 Oklahoma City, OK73134

spinal surgery (cervical/lumbar) carpal tunnel Excl. Body Parts/Svcs: Nothing outside of cervical, lumbar, brain or carpal tunnel American Board of Neurological Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 24

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Kyle Mangels, M.D.

6802 S Olympia Ave Ste 300 Tulsa, OK74132

neurological surgery spine, brain, carpal tunnel. ulnar nerve

[email protected] Contact: Sheila, Jamie Phone: (918) 749-0762 Fax: (918) 744-4246

City of Exam

Tulsa

Excl. Body Parts/Svcs: hips, knees, joints American Board of Neurological Surgery TR

Neurosurgery

John S. Marouk, D.O.

2128 S Atlanta PL Ste 100 Tulsa, OK74114

[email protected] Contact: Phone: (918) 583-5131 Fax: (918) 592-0670

spine, brain only

Tulsa

Excl. Body Parts/Svcs: all other body parts American Osteopathic Board of Surgery T

Neurosurgery

Fadi F Nasr, M.D. [email protected] Contact: Stephanie Phone: (405) 748-3300 Fax: ( )

4120 W Memorial Rd, Ste 300 Oklahoma City, OK73120

-

Spine (neck, back), wrist (carpal tunnel) Excl. Body Parts/Svcs: shoulders, knees, hips, elbows American Board of Neurological Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 25

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Stan Pelofsky, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

neck, back, wrist (carpal tunnel)

[email protected] Contact: Angie Phone: (405) 748-3300 Fax: (405) 748-2920

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: shoulders, knees, lower extremities American Board of Neurological Surgery T

Neurosurgery

Ryan F. Rahhal, M.D.

6767 S Yale Ave Ste A Tulsa, OK74136

[email protected] Contact: Kim Perry, Jacci Carpio Phone: (918) 492-7587 Fax: (918) 492-4033

brain, spine (thoracic, lumbar, & cervical), carpal tunnel

Tulsa

Excl. Body Parts/Svcs: all ot neurosurgical Certification Unknown TR

Neurosurgery

Robert L. Remondino, M.D. [email protected] Contact: Linda Phone: (405) 748-3300 Fax: (405) 749-1671

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

neck, back, wrists (carpal tunnel) Excl. Body Parts/Svcs: shoulders, knees, lower extremities American Board of Neurological Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 26

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

W. Emery Reynolds, M.D.

4120 W Memorial Ste 208 Oklahoma City, OK73120

head, spine

City of Exam

Oklahoma City

NONE Contact: Sondra Phone: (405) 755-3540 Fax: (405) 755-7001 American Board of Neurological Surgery T Neurosurgery

James A. Rodgers, M.D.

6565 S Yale Ste 709 Tulsa, OK74136

cervical & lumbar spine carpal tunnel

Tulsa

Contact: Rita Phone: (918) 481-4965 Fax: (918) 481-4996 American Board of Neurological Surgery R Neurosurgery

Brian E. Snell, M.D. [email protected] Contact: CALLIE Phone: (405) 748-3300 Fax: (405) 749-1671

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

spine (neck, back), wrist (carpal tunnel) Excl. Body Parts/Svcs: shoulders, knees, hips, elbows American Board of Neurological Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 27

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Caple A Spence, M.D.

8121 National Ave Ste 210 Midwest City, OK73110

brain, spine, peripheral nerves

[email protected] Contact: Christy Phone: (405) 455-3393 Fax: (405) 455-7162

City of Exam

MWC

Excl. Body Parts/Svcs: all except brain, spine, peripheral nerves American Board of Neurological Surgery T

Neurosurgery

Robert E. Tibbs, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

Contact: Angie Phone: (405) 748-3300 Fax: (405) 748-1671

TREATMENT AUTHORIZATION for neck, Oklahoma City back, wrists (carpal tunnel) Excl. Body Parts/Svcs: shoulders, knees, lower extremities American Board of Neurological Surgery T

Neurosurgery

Frank J. Tomecek, M.D. [email protected] & [email protected] Contact: Sheila, Susie Phone: (918) 749-0762 Fax: (918) 749-8531

6802 S Olympia Ave Ste 300 Tulsa, OK74132

spine (neck, back), brain, carpal tunnel, ulner nerve Excl. Body Parts/Svcs: legs, hips American Board of Neurological Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 28

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Neurosurgery

Benjamin T. White, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

neck, back, wrist (carpal tunnel)

[email protected] Contact: Kelsey Phone: (405) 748-3300 Fax: (405) 748-1671

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: shoulders, knees, lower extremities American Board of Neurological Surgery T

Neurosurgery

Robert J. Wienecke, M.D.

4120 W Memorial Rd Ste 300 Oklahoma City, OK73120

neck, back, wrists{carpal tunnel)

Oklahoma City

Excl. Body Parts/Svcs: shoulders, knees, lower extremities

Contact: Marlea Phone: (405) 748-3300 Fax: (405) 748-1671

American Board of Neurological Surgery T Neurosurgery

Gregory L. Wilson, D.O.

9709 E 79 Street South Tulsa, OK74133

brain, neck, back

Tulsa

Contact: Pam Phone: (918) 994-4068 Fax: (918) 994-4095 Am Board of Osteopathic Neurological Surgery TR

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 29

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Occupational Medicine

William R. Gillock, M.D.

7170 S Braden Ste 175 Tulsa, OK74136

all body parts

[email protected] Contact: Sharon Phone: (918) 481-0994 Fax: (918) 494-6747

City of Exam

Tulsa

Excl. Body Parts/Svcs: none American Board of Internal Medicine & Preventive Medicine T R MITF

Occupational Medicine

John W. Hallford, D.O.

5682 W Skelly Dr Tulsa, OK74107

[email protected] Contact: Julie Phone: (918) 446-1891 Fax: (918) 446-1894

occupational medicine/urgent care

Tulsa

Excl. Body Parts/Svcs: none American Osteopathic Board of Family Physicians T R MITF

Occupational Medicine

Kent C. Hensley, M.D.* NONE Contact: Yvonne, Leslie Phone: (405) 840-6720 Fax: (405) 840-6723

9433 N Kelley Ave Oklahoma City, OK73131

all Excl. Body Parts/Svcs: psychiatric American Board of Internal Medicine R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 30

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Occupational Medicine

Andrew C. John, M.D.

4323 NW 63 Street Ste 105 Oklahoma City, OK73116

all occupational medicine

[email protected] Contact: Jerri Phone: (405) 843-0610 Fax: (405) 843-0620

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: Psychological/Psychiatric Certification Unknown R MITF

Occupational Medicine

William D. Jones, M.D.

707 NW 13 St Oklahoma City, OK73103

[email protected] Contact: Jeanne Phone: (405) 521-8604 Fax: (405) 521-8605

all occupational medicine (rating only)

Oklahoma City

Excl. Body Parts/Svcs: female reproductive system Certification Unknown R MITF

Occupational Medicine

John A. Munneke, M.D. [email protected] Contact: JoAnne, Kerri Phone: (405) 755-9702 Fax: (405) 755-9718

36 W Memorial Ste B9 Oklahoma City, OK73114

all including occupational medicine, MITF, Form 3, pain management Excl. Body Parts/Svcs: eyes Certification Unknown T R MITF

* Physician has multiple specialties.

Oklahoma City, Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 31

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Occupational Medicine

Robert Paul, M.D.

6717 S Yale Ave Suite 107 Tulsa, OK74136

all within specialty

Contact: Linda Phone: (918) 496-1991 Fax: ( )

City of Exam

Tulsa

Certification Unknown R MITF

Occupational Medicine

Carl B. Pettigrew, D.O.

1211 N Shartel Ste 500 Oklahoma City, OK73103

[email protected] Contact: Karen Phone: (405) 239-7766 Fax: (405) 235-4895

all

Oklahoma City, Tulsa

Excl. Body Parts/Svcs: None Certification Unknown T R MITF

Occupational Medicine

J. A. Snelling, D.O. none Contact: Margaret Phone: (918) 749-3187 Fax: (918) 491-9925

PO Box 702738 Tulsa, OK74170

Spine, Musculoskeletal Excl. Body Parts/Svcs: Cardiac-Respiratory American Board of Family Physicians, Am Board of Preventive Med. R

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 32

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Occupational Medicine

Kenneth R. Trinidad, D.O.*

1006 W 23 St Tulsa, OK74107

all

Tulsa

Excl. Body Parts/Svcs: Lungs

Contact: Rhonda Phone: (918) 742-4881 Fax: (918) 742-5854

Internal Medicine T R MITF Occupational Medicine

Mark Stephen Wilson, M.D.*

5522 S Lewis Tulsa, OK74105

Contact: TU-Sandra, OKC-Tayller Phone: (918) 488-8285 Fax: (405) 949-1801

all orthopedics, continuing medical maintenance Excl. Body Parts/Svcs: None

Tulsa, OKC

Certification Unknown T R MITF Orthopedic Surgery

Kasra Ahmadinia, M.D. [email protected] Contact: Wendy Phone: (918) 494-9300 Fax: ( )

6475 S. Yale Ave Suite 301 Tulsa, OK74136

-

Spine - back and neck

Tulsa

Excl. Body Parts/Svcs: Shoulder, Elbow, Wrist, Hand, Knee, Hip, Foot, Ankle Certification Unknown TR

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 33

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Gary B. Anderson, M.D.*

3301 NW 50 St Oklahoma City, OK73112

knees, shoulders, hips, elbows

Oklahoma City

[email protected] Contact: Scheduling Phone: (405) 947-0911 Fax: (405) 947-0775

Excl. Body Parts/Svcs: spine (back, neck), hands American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

John W. Anderson, M.D.

3301 NW 50 St Oklahoma City, OK73112

[email protected] Contact: Central Scheduling Phone: (405) 947-0911 Fax: (405) 948-5177

foot and ankle

Oklahoma City

Excl. Body Parts/Svcs: spine (neck, back) and upper extremities American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Clint Justin Basener, D.O.* [email protected] Contact: Pam Phone: (918) 994-4068 Fax: (918) 994-4095

9709 E 79 Street S Tulsa, OK74133-4566

all within specialty

Tulsa

Excl. Body Parts/Svcs: All except brain, neck, spine Certification Unknown TR

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 34

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Jaafar M. Bazih, M.D.

4802 S 109 E Ave Tulsa, OK74146

extremities, hands

City of Exam

Tulsa

Excl. Body Parts/Svcs: spine: back & neck

Contact: Denise Phone: (918) 392-1400 Fax: (918) 392-1401

American Board of Orthopedic Surgery T Orthopedic Surgery

James F. Bischoff, M.D.*

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

[email protected] Contact: Damita Carter 918-481-7658 Phone: (918) 494-9300 Fax: (918) 494-9397

hands, wrists

Tulsa

Excl. Body Parts/Svcs: spine, elbows, shoulders, feet, ankles, knees, hips, rate only cases American Board of Orthopedic Surgery TR

Orthopedic Surgery

David Bobb, M.D. [email protected] Contact: Donna Phone: (405) 364-8855 Fax: ( )

825 E Robinson Norman, OK73071

all except back & head Excl. Body Parts/Svcs: back & head

American Board of Orthopaedic Surgery T R MITF

* Physician has multiple specialties.

Norman

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 35

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

James Lee Bond, M.D.

3400 W Tecumseh Rd Ste 101 Norman, OK73072

knees, shoulders, elbows, hands

[email protected] Contact: BROOKE Phone: (405) 517-3719 Fax: (405) 360-6769

City of Exam

Norman

Excl. Body Parts/Svcs: hips, back, foot, ankle American Board of Orthopaedic Surgery MITF

Orthopedic Surgery

Bradford Boone, M.D.*

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

[email protected] Contact: Wendy Phone: (918) 494-9300 Fax: (918) 494-9397

knees, shoulders, elbows

Tulsa

Excl. Body Parts/Svcs: spine, hips, feet, ankles, hands & rate only cases American Board of Orthopedic Surgery/Sports Medicine TR

Orthopedic Surgery

R. Tyler Boone, M.D. [email protected] Contact: Lori Phone: (918) 494-9300 Fax: (918) 494-9397

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

neck, back Excl. Body Parts/Svcs: hands, hips, knees, feet, ankles shoulders, elbows, no rate only cas American Board of Orthopedic Surgery/AmBd Ortho Surg of the Spine TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 36

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Steven P. Brantley, M.D.

3301 NW 50th Street Oklahoma City, OK73112

knees and shoulders

[email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: ( )

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: Spine (neck and back) Certification Unknown T

Orthopedic Surgery

Christopher A. Browne, M.D.

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

[email protected] Contact: Lori Phone: (918) 494-9300 Fax: (918) 494-9397

hips, knees

Tulsa

Excl. Body Parts/Svcs: hands, spine, feet, ankles, shoulders, elbows, no rate only cases American Board of Orthopedic Surgery TR

Orthopedic Surgery

James D. Cash, M.D.* [email protected] Contact: Phone: (918) 481-2767 Fax: (918) 481-7611

6585 S Yale Ave Ste 200 Tulsa, OK74136

knees, shoulders Excl. Body Parts/Svcs: none American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 37

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Brian Chalkin, D.O.*

1809 E 13 St Ste 100 Tulsa, OK74104

Shoulder, Elbow, Hand, Wrist

Tulsa

[email protected] Contact: Rae Phone: (918) 582-6800 Fax: (918) 301-4293

Excl. Body Parts/Svcs: Knee, Ankle, Hip, Spine, Neck, Pelvis American Osteopathic Board of Orthopedic Surgery TR

Orthopedic Surgery

Brian Clowers, M.D.

3400 W Tecumseh Ste 101 Norman, OK73072

[email protected] Contact: Brooke Phone: (405) 517-3719 Fax: (405) 360-6769

foot, ankle

OKC, Norman

Excl. Body Parts/Svcs: all except foot & ankle American Board of Orthopedic Surgery TR

Orthopedic Surgery

Ashley Cogar, M.D. [email protected] Contact: Diana, Jennifer Phone: (405) 419-5665 Fax: (405) 419-5429

9800 Broadway Extension Suite 201 Oklahoma City, OK73114

elbow, wrist, hand

Oklahoma City

Excl. Body Parts/Svcs: spine, shoulder, hip, knee, ankle or foot Certification Unknown TR

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 38

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Arthur Hobart Conley, III, M.D.

P O Box 891328 Oklahoma City, OK73189

(spine) back and neck only

Oklahoma City

[email protected] Contact: Sarita Phone: (405) 703-7306 Fax: (405) 703-7334

Excl. Body Parts/Svcs: all except spine American Board of Orthopedic Surgery T

Orthopedic Surgery

Jimmy Harold Conway, M.D.

10001 S Western Ste 101 Oklahoma City, OK73139-2997

[email protected] Contact: Nancy Phone: (405) 692-3749 Fax: (405) 692-3789

elbows, knees

Oklahoma City

Excl. Body Parts/Svcs: spine, feet, hands American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Steven D. Coupens, M.D.

9800 Broadway Extension Suite 201 Oklahoma City, OK73114

all body parts

[email protected] Contact: Phone: (405) 427-6776 Fax: (405) 424-5415 American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

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Page: 39

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Thomas G. Craven, M.D.

6585 S Yale Ste 200 Tulsa, OK74136

spine (neck, back)

Tulsa

[email protected] Contact: Melissa, Linda Phone: (918) 481-2767 Fax: (918) 481-7669

Excl. Body Parts/Svcs: hands, wrists, knees, ankles American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Scott De La Garza, M.D.

608 NW 9 Street Ste 6000 Oklahoma City, OK73102

[email protected] Contact: Brooke Phone: (405) 517-3719 Fax: (405) 360-6769

spine only (lumbar, cervical, thorasic)

Oklahoma City

Excl. Body Parts/Svcs: all except spine American Board of Orthopaedic Surgery TR

Orthopedic Surgery

Kevin M. Dukes, M.D.

Contact: Denise Phone: (918) 392-1437 Fax: (918) 392-1401

4802 S 109 E Ave Tulsa, OK74146

shoulders Excl. Body Parts/Svcs: all but shoulder American Board of Orthopedic Surgery T

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 40

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Ronald Matthew Dumigan, M.D.

1110 N Lee Oklahoma City, OK73103

Knees, Shoulders, Elbows, ankles,

Oklahoma City, Edmond, Norman

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9505

Excl. Body Parts/Svcs: Spine, Neck, Hip American Board of Orthopedic Surgery T

Orthopedic Surgery

Rory C. Dunham, D.O. [email protected] Contact: Phone: (405) 759-2562 Fax: ( )

9060 Harmony Drive, Ste. B Midwest City, OK73130

hand, knee, shoulder, ankle, elbow, hip, feet, back

Midwest City

American Osteopathic Board of Orthopedic Surgery T

Orthopedic Surgery

Scott J. Dunitz, M.D.

Contact: Latoya Phone: (918) 392-1403 Fax: (918) 392-1401

4802 S 109 E Ave Tulsa, OK74146

hips, knees (adult reconstruction) Excl. Body Parts/Svcs: back, neck, hands American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 41

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Eugene G. Feild, M.D.

6600 S Yale Ste 1315 Tulsa, OK74136-3346

all within specialty

City of Exam

Tulsa

[email protected] Contact: Nancy Phone: (918) 481-7770 Fax: (918) 481-7797 American Board of Orthopedic Surgery T R MITF Orthopedic Surgery

David J. Flesher, M.D.

3301 NW 50 St Oklahoma City, OK73112

[email protected] Contact: Central Scheduling Phone: (405) 947-0911 Fax: (405) 948-5177

knees, shoulders, hips, elbows

Oklahoma City

Excl. Body Parts/Svcs: spine (neck & back), feet, hands American Board of Orthopedic Surgery T

Orthopedic Surgery

Thomas H. Flesher, III, M.D. [email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: (405) 948-5171

3301 NW 50 St Oklahoma City, OK73112

shoulders, ankles, knees, hips Excl. Body Parts/Svcs: spine (back, neck), wrists, hands American Board of Orthopedic Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 42

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Winston Fong, M.D.

1110 N Lee Oklahoma City, OK73103

spine only (cervical, thoracic, lumbar)

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9421

City of Exam

OKC, Edmond

Excl. Body Parts/Svcs: all except spine (shoulders,elbows,hands,wrist,hips, knees,ankles/f American Board of Orthopaedic Surgery TR

Orthopedic Surgery

Dennis E. Foster, M.D.

3130 SW 89 St Ste 100 Oklahoma City, OK73159-7900

all

Oklahoma City

Excl. Body Parts/Svcs: None

Contact: Phone: (405) 378-4472 Fax: (405) 378-3580

American Board of Orhtopedic Surgery T R MITF Orthopedic Surgery

Jeff A. Fox, M.D.*

Contact: appt desk Phone: (918) 481-7658 Fax: (918) 481-7611

6585 S Yale Ave Ste 200 Tulsa, OK74136

knees, ankles, elbow, shoulders Excl. Body Parts/Svcs: hand, spine American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 43

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Sami R. Framjee, M.D.

2000 S Wheeling Ave Ste 1110 Tulsa, OK74104

spine and general orthopaedics

Tulsa (Treat only) and Oklahoma City

[email protected] Contact: Teri Phone: (918) 294-0080 Fax: (918) 742-2119

Excl. Body Parts/Svcs: None American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Joel L. Frazier, M.D.* Contact: eRNEST Phone: (405) 631-4263 Fax: ( )

1044 SW 44 St Ste 600 Oklahoma City, OK73109 -

hands, upper extremities, elbows, wrists Excl. Body Parts/Svcs: all except hands, elbows, wrists

Oklahoma City

American Board of Orthopedic Surgery TR Orthopedic Surgery

Charles H. Funderburk, M.D.* [email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 522-9474

1110 N Lee Oklahoma City, OK73103-2612

hands, shoulders, elbows, knees, wrists, forearm Excl. Body Parts/Svcs: neck, back, hips, feet American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Oklahoma Ctiy, Edmond

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 44

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Timothy Michael Geib, M.D.

13401 N Western Ave, Ste. 301 Oklahoma City, OK73114

knees, shoulders, elbows, hips, hands, arms

[email protected] Contact: Brooke Phone: (405) 517-3719 Fax: ( )

City of Exam

Edmond, OKC

Excl. Body Parts/Svcs: feet, back

-

American Board of Orthopedic Surgery TR Orthopedic Surgery

Robert A. German, M.D.

1110 N Lee Oklahoma City, OK73103-2612

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9474

knees, shoulders, elbows, ankles, arms, legs

Oklahoma City, Norman

Excl. Body Parts/Svcs: spine, neck American Board of Orthopedic Surgery TR

Orthopedic Surgery

Greg Halko, M.D.* [email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: (405) 942-5043

3301 NW 50 Oklahoma City, OK73112

hands, upper extremities Excl. Body Parts/Svcs: spine, (neck, back) and lower extremities American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 45

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Kevin Wayne Hargrove, M.D.

101 S Saints Blvd Ste 101 Edmond, OK73034

Orthopaedic Surgery; Sports Medicince-Shoulders and knees

[email protected] Contact: Work Comp Cordinator Phone: (405) 513-8326 Fax: (405) 513-7739

City of Exam

Edmond

Excl. Body Parts/Svcs: Surgical Spine Cases American Board of Orthopedic Surgery T MITF

Orthopedic Surgery

Bryan Hawkins, M.D.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

[email protected] Contact: CSOS Phone: (918) 481-2767 Fax: (918) 481-7611

ankles, knees, feet, hip

Tulsa

Excl. Body Parts/Svcs: neck, spine, wrists, hands, elbows American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Randall L. Hendricks, M.D. [email protected] Contact: Allison Phone: (918) 481-2767 Fax: (918) 481-7611

6585 S Yale Ste 200 Tulsa, OK74136

neck, spine Excl. Body Parts/Svcs: shoulders, elbows, hips, knees hands, wrists, ankle American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 46

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

David R. Hicks, M.D.

6585 S Yale Ave Ste 200 Tulsa, OK74136

neck and spine

Tulsa

[email protected] Contact: Central States Orthopedics Phone: (918) 481-2767 Fax: (918) 481-7611

Excl. Body Parts/Svcs: hands, wrists, elbows, shoulders, knees, hips, ankles American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Robert Frazer Hines, M.D.

9800 Broadway Extension Suite 201 Oklahoma City, OK73114

[email protected] Contact: Naci Phone: (405) 348-6004 Fax: (405) 715-8853

shoulders, knees

Oklahoma City

Excl. Body Parts/Svcs: Neck, back, foot and ankle, elbow, hip American Board of Orthopedic Surgery T

Orthopedic Surgery

Gregory R. Holt, M.D. [email protected] Contact: Rae Cheatham Phone: ( ) Fax: (918) 582-6060

1809 E 13 St Ste 100 Tulsa, OK74104

hips, knees, shoulders Excl. Body Parts/Svcs: Back, Neck American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 47

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Thomas C. Howard, M.D.*

1110 N Lee Oklahoma City, OK73103-2612

hands, shoulders, knees, hips and feet

Oklahoma City, Norman

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9424

Excl. Body Parts/Svcs: spine, (neck,back) American Board of Orthopedic Surgery TR

Orthopedic Surgery

John B. Hughes, D.O.

2149 SW 59 St Ste 102 Oklahoma City, OK73119

[email protected] Contact: Tammy Phone: (405) 682-5351 Fax: (405) 685-5563

all

Oklahoma City

Excl. Body Parts/Svcs: none American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Christopher Shane Hume, D.O. [email protected] Contact: scheduler Phone: (405) 427-3705 Fax: ( )

10001 S. Western Ave Suite 202 Oklahoma City, OK73139

spine (neck & back)

Oklahoma City

Excl. Body Parts/Svcs: all except speciality Board Eligible T

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 48

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Antoine I. Jabbour, M.D.

4802 S 109 E Ave Tulsa, OK74146

knees, shoulders

Tulsa

[email protected] Contact: Latoya Phone: (918) 392-1400 Fax: (918) 392-1401

Excl. Body Parts/Svcs: spine, hands American Board of Orthopedic Surgery T

Orthopedic Surgery

Paul Jacob, D.O.

9800 Broadway Extension Suite 201 Oklahoma City, OK73114

[email protected] Contact: Joann Ellis Phone: (405) 424-5426 Fax: (405) 424-5416

adult reconstruction total joint replacement

Oklahoma City

Excl. Body Parts/Svcs: uper extremity injuries Certification Unknown T MITF

Orthopedic Surgery

Thomas P. Janssen, M.D. [email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9474

1110 N Lee Oklahoma City, OK73103-2612

knees, hips, shoulders, feet, hands Excl. Body Parts/Svcs: neck,back American Board of Family Medicine & Orthopaedic Surgery TR

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 49

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

J. Calvin Johnson, M.D.

9800 Broadway Extension Suite 203 Oklahoma City, OK73114

knees, shoulders

Oklahoma City

[email protected] Contact: Scheduler Phone: (405) 419-5412 Fax: (405) 419-5468

Excl. Body Parts/Svcs: back,hands,ankles American Board of Orthopedic Surgery T

Orthopedic Surgery

Wayne A. Johnson, M.D.

8212 NW Stonebridge Ct Lawton, OK73506

[email protected] Contact: Cassandra Phone: (580) 536-2265 Fax: (580) 536-7805

shoulder, knee, hand/wrist, foot/ankle

Lawton

Excl. Body Parts/Svcs: back American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Daniel J. Jones, M.D. [email protected] Contact: Alice Mata Phone: (405) 632-4468 Fax: (405) 632-4317

8100 S Walker Ave Bldg A Oklahoma City, OK73139

knee, shoulder, foot, ankle, legs, arms, elbows Excl. Body Parts/Svcs: spine and neck American Board of Orthopaedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 50

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Michael E. Kiehn, M.D.

3301 NW 50 St Oklahoma City, OK73112

knees, shoulders

Oklahoma City

[email protected] Contact: Jaye Dee Watts Phone: (405) 947-0911 Fax: (405) 942-5043

Excl. Body Parts/Svcs: spine (neck, back) American Board of Orthopaedic Surgery T R MITF

Orthopedic Surgery

Richard Kirkpatrick, M.D.*

3400 W Tecumseh Rd Ste 101 Norman, OK73072

[email protected] Contact: Brooke Phone: (405) 517-3719 Fax: (405) 360-6769

knees, shoulders, elbows, hands, hips, ankles, arms

Oklahoma City, Norman

Excl. Body Parts/Svcs: spine American Board of Orthopaedic Surgery TR

Orthopedic Surgery

Zakary A. Knutson, M.D. [email protected] Contact: Brooke Phone: (405) 517-3719 Fax: ( )

3400 W Tecumseh Ste 101 Norman, OK73072

hips, knees, shoulders, elbows Excl. Body Parts/Svcs: foot, ankle, neck and back

Certification Unknown TR

* Physician has multiple specialties.

Norman, Edmond

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 51

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Mark F. Kowalski, M.D.

4140 W Memorial Rd Ste 308 Oklahoma City, OK73120

all orthopaedic surgery except spine, hips, and neck Excl. Body Parts/Svcs: hips, back, neck

Contact: Kayla, Shawna, Cathy Phone: (405) 749-7031 Fax: (405) 749-7036

City of Exam

Oklahoma City

American Board of Orthopedic Surgery TR Orthopedic Surgery

Sarat Kunapuli, D.O.

Contact: Lori Phone: (918) 494-9300 Fax: ( )

6475 S Yale Suite 301 Tulsa, OK74136

Knees, Hips and Shoulders

Tulsa

Excl. Body Parts/Svcs: all except listed American Osteopathic Association TR

Orthopedic Surgery

E. Alexander L'Heureux, Jr., M.D.

Contact: Jennifer Phone: (405) 844-5222 Fax: (405) 744-2166

1405 NW 150 St Edmond, OK73013

cervical, thoracic and lumbar spine Excl. Body Parts/Svcs: all except spine American Board of Orthopedic Surgery & Spine Surgery T

* Physician has multiple specialties.

Edmond

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 52

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Ronald S. LaButti, D.O.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

hips, knees, ankles, foot

Tulsa

[email protected] Contact: appt desk Phone: (918) 481-2767 Fax: (918) 481-7611

Excl. Body Parts/Svcs: hand, elbow, arms, shoulders American Osteopathic Aacademy of Orthopedics T R MITF

Orthopedic Surgery

Bradley J. Lawson, M.D. [email protected] Contact: scheduling Phone: (918) 481-2767 Fax: ( )

6585 S Yale Ave Ste 200 Tulsa, OK74136

ankle, shoulder, hip, knee, foot, elbow, hand, wrist

Tulsa

Excl. Body Parts/Svcs: none

-

American Board of Orthopaedic Surgery T R MITF Orthopedic Surgery

Brian A. Levings, D.O. [email protected] Contact: Alice Mata Phone: (405) 632-4468 Fax: (405) 632-4317

8100 S Walker Ave Bldg A Oklahoma City, OK73139

arms, legs, shoulders, knees, feet, ankles, elbows Excl. Body Parts/Svcs: back, neck American Osteopathic Board of Orthopaedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 53

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Alan G. Lewis, M.D.

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

feet, ankles, knees

Tulsa

[email protected] Contact: Damita Carter 918-481-7658 Phone: (918) 494-9300 Fax: (918) 494-9397

Excl. Body Parts/Svcs: spine, hips, hands, elbows, shoulders, rate only cases American Board of Orthopedic Surgery TR

Orthopedic Surgery

J. Patrick Livingston, M.D.

1211 N Shartel Suite 500 Oklahoma City, OK73103

Contact: Allison Phone: (405) 463-0407 Fax: (405) 463-0425

orthopedic surgery, neck, back, shoulders, hips, arms, legs, hands, feet

Oklahoma City

Excl. Body Parts/Svcs: head, brain, lungs, heart urogenital, gastrointestinal American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Jay D. Lorton, M.D. [email protected] Contact: Lori Phone: (918) 494-9300 Fax: (918) 494-9397

6475 S Yale Ave Ste 301 Tulsa, OK74136

knees, shoulders, elbows Excl. Body Parts/Svcs: spine, hands, hips, feet American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 54

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Paul D. Maitino, D.O.

3110 SW 89 Street Ste 200D Oklahoma City, OK73159

hips, knees, shoulders

Oklahoma City

[email protected] Contact: Jessica Phone: (405) 680-5633 Fax: (405) 735-6435

Excl. Body Parts/Svcs: head Orthopedic Surgery T R MITF

Orthopedic Surgery

Bradley Margo, M.D.

1110 N Lee Oklahoma City, OK73103-2612

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9475

shoulders, knees

Oklahoma City

Excl. Body Parts/Svcs: backs, necks, hips, feet, hands American Board of Orthopaedic Surgery TR

Orthopedic Surgery

Robert Marsh, D.O.

Contact: Wendy Phone: (918) 494-9300 Fax: ( )

6475 S Yale Ave. Suite 301 Tulsa, OK74136

FOOT, ANKLE Excl. Body Parts/Svcs: all but foot and ankle

American Osteopathic Association TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 55

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

James C. Mayoza, M.D.

6122 E 61 St Tulsa, OK74136-2117

lumbar and cervical spine & extremities

City of Exam

Tulsa

Contact: Nicci or Morgie Phone: (918) 492-3133 Fax: (918) 493-2215 American Board of Orthopedic Surgery T R MITF Orthopedic Surgery

Yogesh Mittal, M.D.

1809 E 13 St Ste 100 Tulsa, OK74104

Contact: Nancy 918-925-3204 Phone: (918) 582-6800 Fax: (918) 301-4293

Orthopedic Surgeon-Total JointKnees-Hips Excl. Body Parts/Svcs: spine

Tulsa

American Board of Orthopaedic Surgery T Orthopedic Surgery

Mac E. Moore, M.D.

Contact: Belinda Phone: (405) 692-3737 Fax: (405) 692-3707

10001 S Western Ste 200 Oklahoma City, OK73139-2997

shoulders, elbows, knees Excl. Body Parts/Svcs: none American Board of Orthopaedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 56

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Jeffrey R. Morris, D.O.*

6585 S. Yale Ave Suite 200 Tulsa, OK74136

shoulder, hand, wrist, hip, knee, ankles & total joint replacements

Tulsa

[email protected] Contact: Reggie 918-583-7076 Phone: (918) 481-2767 Fax: (918) 583-7908

Excl. Body Parts/Svcs: neck, spine American Osteopathic Board of Orthopedfic Surgery T R MITF

Orthopedic Surgery

Mark Robert Moses, M.D.

825 E Robinson Norman, OK73071

[email protected] Contact: Gaylene Phone: (405) 364-7900 Fax: (405) 366-6214

hips, knees, shoulders,hands, wrists

Norman

Excl. Body Parts/Svcs: neck, back American Board of Orthopaedic Surgery TR

Orthopedic Surgery

Ryan L. Nelson, D.O

Contact: Joann Phone: (405) 330-8847 Fax: ( )

1616 S. Kelly Edmond, OK73013

-

shoulder, elbow, knee (trauma/fractures) hip, wrist, ankle

Edmond

Excl. Body Parts/Svcs: none Certification Unknown T R MITF

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 57

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

David E. Nonweiler, M.D.

6585 S Yale Ave Ste 200 Tulsa, OK74136

shoulders, knees

Tulsa

[email protected] Contact: Melissa Phone: (918) 481-2767 Fax: (918) 481-7611

Excl. Body Parts/Svcs: neck and spine American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

M. Sean O'Brien, D.O.*

Contact: Marilyn Phone: (405) 759-2663 Fax: ( )

3110 SW 89th St., Suite 200C Oklahoma City, OK73159

Hands and Shoulders

Oklahoma City

Excl. Body Parts/Svcs: back, neck, feet American Osteopathic Board of Orthopedic Surgery T

Orthopedic Surgery

James M. Odor, M.D. Contact: Valerie, Renee Phone: (405) 242-4345 Fax: (405) 242-4333

14100 Parkway Commons Dr Ste 200 Oklahoma City, OK73134

cervical, thoracic & lumbar spine (neck and back) Excl. Body Parts/Svcs: None American Board of Orthopedic Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

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Page: 58

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

L. Todd Olsen, D.O.

Olsen Orthopedics 3400 S Douglas Blvd Ste 302 Oklahoma City, OK73150

knees, shoulders

MWC

Contact: Wendy, Cheryl Phone: (405) 733-8000 Fax: (405) 733-7820

Excl. Body Parts/Svcs: backs American Osteopathic Board of Orthopedic Surgery T

Orthopedic Surgery

Victor R. Palomino, D.O.* [email protected] Contact: Rae Phone: (918) 582-6800 Fax: ( )

1809 E 13 St Ste 100 Tulsa, OK74104

Orthopedics; Sports Medicine

Tulsa

Excl. Body Parts/Svcs: Back, Foot/ankle, hand American Osteopathic Board T

Orthopedic Surgery

Kris Parchuri, D.O. sostulsa.com Contact: Sarah Phone: (539) 664-4448 Fax: (539) 664-4288

9101 S Toledo Ave Ste B Tulsa, OK74137

spine

Tulsa

Excl. Body Parts/Svcs: hands, feet AOA T R MITF

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

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Page: 59

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

Andrew Parkinson, M.D.

3301 NW 50 St Oklahoma City, OK73112

spine, (neck, back), lower extremities

Oklahoma City

[email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: ( )

Excl. Body Parts/Svcs: all except spine & lower extremities

-

American Board of Orthopaedic Surgery T R MITF Orthopedic Surgery

Ghazi M. Rayan, M.D.*

3366 NW Expressway Ste 700 Oklahoma City, OK73112-4418

shoulder, elbow, wrist, hand

Oklahoma City

Excl. Body Parts/Svcs: back

Contact: Phone: (405) 945-4888 Fax: (405) 945-4887

American Board of Orthopedic Surgery/ Am Bd of Ortho Surg of Hand T R MITF Orthopedic Surgery

Vytautas M. Ringus, M.D. [email protected] Contact: Monique Phone: (405) 364-7900 Fax: (405) 310-6866

825 E Robinson Norman, OK73071

foot and ankle

Norman

Excl. Body Parts/Svcs: none Certification Unknown T R MITF

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

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Page: 60

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

R. Clio Robertson, M.D.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

neck, spine, shoulder, elbows, wrists, hips, knees, ankles

Tulsa

[email protected] Contact: Phone: (918) 481-2767 Fax: (918) 481-7611 American Board of Orthopedic Surgery T R MITF Orthopedic Surgery

Richard A. Ruffin, M.D.*

3301 NW 50 Oklahoma City, OK73112-5691

hands, wrists, elbows, shoulders

Oklahoma City

Excl. Body Parts/Svcs: neck & back (spine), feet, knees

Contact: Central Scheduling Phone: (405) 947-0911 Fax: (405) 947-4263

American Board of Orthopedic Surgery, Hand Surgery T Orthopedic Surgery

Houshang Seradge, M.D.* Contact: Misti Phone: (405) 634-4263 Fax: ( )

1044 SW 44 Street Suite 518 Oklahoma City, OK73109

spine, foot, wrist, elbow, shoulder, hip, knee, ankle

American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

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Page: 61

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Blake Shockley, M.D.

6585 S Yale Ave Suite 200 Tulsa, OK74136

shoulder, elbow, hip, knee and ankle

[email protected] Contact: Jennifer. Angie Phone: (918) 481-2767 Fax: ( )

City of Exam

Tulsa area

Excl. Body Parts/Svcs: spine, hand

-

American Board of Orthopedic Surgery T R MITF Orthopedic Surgery

James C. Slater, M.D.

4802 S 109 E Ave Tulsa, OK74146

adult reconstruction

Tulsa

Excl. Body Parts/Svcs: hands, feet,back, neck, (spine)

Contact: Latoya Phone: (918) 392-1437 Fax: (918) 392-1401

American Board of Orthopedic Surgery T Orthopedic Surgery

Glenn L. Smith, D.O. [email protected] Contact: Linda Phone: (405) 682-4651 Fax: (405) 682-3391

2149 SW 59 Ste 101 Oklahoma City, OK73119

all orthopedic surgery

Oklahoma City

Excl. Body Parts/Svcs: Feet Orthopedic Surgery T

* Physician has multiple specialties.

Date: 01/19/2017 Time: 08:45

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Page: 62

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Sheryl C. Smith, M.D.

9800 Broadway Extension Suite 201 Oklahoma City, OK73114

foot, ankle

[email protected] Contact: Kim Phone: (405) 419-5610 Fax: (405) 419-5429

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: all except foot & ankle Certification Unknown TR

Orthopedic Surgery

Cheng-Lun Soo, M.D.

1044 SW 44 Street Oklahoma City, OK73109

[email protected] Contact: Ernest Phone: (405) 631-4263 Fax: (405) 631-1767

spine, neck, lumbar, cervical

Oklahoma City

Excl. Body Parts/Svcs: all except neck and back American Board of Orthopedic Surgery TR

Orthopedic Surgery

Richard M. Stamile, M.D. [email protected] Contact: Latoya Phone: (918) 392-1437 Fax: (918) 392-1401

4802 S 109 E Ave #100 Tulsa, OK74146

general orthopedics no surgery Excl. Body Parts/Svcs: back, neck, hands American Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

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Page: 63

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Orthopedic Surgery

Wesley Michael Stotler, D.O.

4802 S 109 E Ave Tulsa, OK74146

foot, ankle

[email protected] Contact: Denise Phone: (918) 392-1403 Fax: (918) 392-1401

City of Exam

Tulsa

Excl. Body Parts/Svcs: all except feet and ankles American Osteopathic Board of Orthopedic Surgery T

Orthopedic Surgery

Robert S. Unsell, M.D.

10001 S Western Ste 101 Oklahoma City, OK73139

[email protected] Contact: Darcy Phone: (405) 692-3700 Fax: (405) 923-3783

hands, wrist, elbows

Oklahoma City

Excl. Body Parts/Svcs: spine, lower extremities Certification Unknown T R MITF

Orthopedic Surgery

Mark Stephen Wilson, M.D.* Contact: TU-Sandra, OKC-Tayller Phone: (918) 488-8285 Fax: (405) 949-1801

5522 S Lewis Tulsa, OK74105

all orthopedics, continuing medical maintenance Excl. Body Parts/Svcs: None Certification Unknown T R MITF

* Physician has multiple specialties.

Tulsa, OKC

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 64

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedic Surgery

David K. Wong, M.D.

6585 S Yale Ave Ste 200 Tulsa, OK74136

hands, wrists, elbows, shoulders

Tulsa

[email protected] Contact: Patti Phone: (918) 481-2767 Fax: (918) 481-7611

Excl. Body Parts/Svcs: neck, spine, knees, hips, ankles American Board of Orthopedic Surgery T R MITF

Orthopedic Surgery

Michael Wright, M.D.

3115 SW 89 Oklahoma City, OK73159

Spine (evaluat all body parts)

Oklahoma City

Excl. Body Parts/Svcs: None

Contact: Krista Phone: (405) 424-5630 Fax: (405) 692-1632

American Board of Spine Surgery TR Orthopedic Surgery

Gregory J. Zeiders, D.O. [email protected] Contact: Lindsay Phone: (405) 509-7370 Fax: (405) 509-7373

1800 S. Renaissance Blvd, Suite 210 Edmond, OK73013

hands, wrists, elbows, shoulders, feet, ankles, knees, hips Excl. Body Parts/Svcs: spine American Osteopathic Board of Orthopedic Surgery TR

* Physician has multiple specialties.

Edmond, Oklahoma City, Shawnee

Date: 01/19/2017 Time: 08:45

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Page: 65

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedics

Darnell E. Blackmon, M.D.*

1809 E 13 Ste 100 Tulsa, OK74104

Sports Medicine, Food and Ankle

Tulsa

Excl. Body Parts/Svcs: spine, hand

Contact: Rae Phone: (918) 582-6800 Fax: (918) 582-6060

American Board of Orthopaedic Surgery TR Orthopedics

Joel M. Davis, M.D.

3301 NW 50 Street Oklahoma City, OK73112

[email protected] Contact: central scheduling Phone: (405) 947-0911 Fax: (405) 947-1341

lower extremities, feet, ankles

OKC

Excl. Body Parts/Svcs: Spine (neck, back) Certification Unknown T R MITF

Orthopedics

William Bentley Edmonds, M.D. [email protected] Contact: Lori Phone: (405) 230-9270 Fax: (405) 230-9424

1110 N Lee Oklahoma City, OK73103-2612

foot, ankle Excl. Body Parts/Svcs: all except foot and ankle American Board of Orthopaedic Surgery TR

* Physician has multiple specialties.

Oklahoma City, Edmond, Norman

Date: 01/19/2017 Time: 08:45

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Page: 66

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedics

David Holden, M.D.

1110 N Lee Oklahoma City, OK73103-2612

knees & shoulders only

Oklahoma City, Norman

[email protected] Contact: Lori Phone: (405) 230-9270 Fax: ( )

Excl. Body Parts/Svcs: Spine, Neck, Hip, Ankles, Feet, Elbows

-

American Board of Orthopaedic Surgery & Sports Medicine T Orthopedics

Michael Brandon Johnson, M.D.

9800 Broadway Extension Suite 203 Oklahoma City, OK73114

all within specialty

OKC

Excl. Body Parts/Svcs: Spine

Contact: Debra Lewis Phone: (405) 424-5417 Fax: (405) 424-5418

Certification Unknown T Orthopedics

Faustino Kazenske, D.O.

Contact: Central Scheduling Phone: (405) 947-0911 Fax: ( )

3301 NW 50th Street Oklahoma City, OK73112

Lower extremities, hips, knees Excl. Body Parts/Svcs: Upper extremities and back

Certification Unknown T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 67

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Orthopedics

Richard Kirkpatrick, M.D.*

3400 W Tecumseh Rd Ste 101 Norman, OK73072

knees, shoulders, elbows, hands, hips, ankles, arms

Oklahoma City, Norman

[email protected] Contact: Brooke Phone: (405) 517-3719 Fax: (405) 360-6769

Excl. Body Parts/Svcs: spine American Board of Orthopaedic Surgery TR

Orthopedics

John Wheeler, M.D.

Contact: Kim Phone: (405) 424-5630 Fax: ( )

3115 SW 89 Oklahoma City, OK73159

all within specialty

Oklahoma City

Excl. Body Parts/Svcs: none American board of Orthopedic Surgery TR

Otolaryngology

R. Stanley Baker, M.D. [email protected] Contact: Dawn Phone: (405) 946-5563 Fax: ( )

3400 NW 56 St Oklahoma City, OK73112

ears Excl. Body Parts/Svcs: all other than ears

American Board of Otolaryngology TR

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 68

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Otolaryngology

Alen Munson Fuller, M.D.

1725 E 19 St Ste 100 Tulsa, OK74104

ears (cumulative hearing loss)

[email protected] Contact: Betsi Phone: (918) 742-7376 Fax: (918) 743-2117

City of Exam

Tulsa

Excl. Body Parts/Svcs: surgical cases American Board of Otolaryngology TR

Otolaryngology

John R. Houck, M.D.

920 Stanton L Young WP 1290 Oklahoma City, OK73104

[email protected] Contact: Tiffney tiffaney-cardwell@ouhs Phone: (405) 271-1368 Fax: (405) 271-3248

ear, nose, throat

OKC

Excl. Body Parts/Svcs: complaints of dizziness or hearing loss American Board of Otolaryngology T

Otolaryngology

Paul David Hunter, M.D.* [email protected] Contact: Dianne Hunter Phone: (405) 272-6027 Fax: (405) 272-8315

535 NW 9th Street #300 Oklahoma City, OK73102

Ears, nose, throat and facial trauma Excl. Body Parts/Svcs: all others but listed AM Board of Otolaryngology T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 69

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Otology

Mark Wood, M.D.

3400 NW 56 St Oklahoma City, OK73112

ears, hearing, including dizziness

[email protected] Contact: Valoree Phone: (405) 946-5563 Fax: (405) 945-7185

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: anything other than ears American Board of Otolaryngology TR

Physical Medicine and Rehabilitation

Donald E. Adams, M.D.

1616 S Kelly Edmond, OK73013-3651

[email protected] Contact: Joann Phone: (405) 330-0032 Fax: (405) 330-0092

pain management

Edmond

Excl. Body Parts/Svcs: feet, ankles American Board of Medicine & Rehabilitation & Pain Medicine TR

Physical Medicine and Rehabilitation

Archana Barve, M.D. [email protected] Contact: Stacey Phone: (405) 949-6481 Fax: (405) 795-5909

3613 NW 56 STREET STE 140 Oklahoma City, OK73112

sports medicine, physical medicine & rehabilitation Excl. Body Parts/Svcs: spinal cord injury with paraplegia, quadriplegia American Board of Physical Medicine/Rehabilitation T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 70

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Physical Medicine and Rehabilitation

Albert J. Bisson, M.D.

4120 W Memorial Rd Ste 118 Oklahoma City, OK73120

physiatry - head, spine, upper and lower extremities, nerve and joint problems

Oklahoma City

[email protected] Contact: Cecylia Phone: (405) 748-4700 Fax: (405) 748-5638

Excl. Body Parts/Svcs: narcotic mngmt, rsd American Board of Physical Medicine/Rehabilitation TR

Physical Medicine and Rehabilitation

Michael S. Brown, M.D.

4120 W Memorial Rd Ste 118 Oklahoma City, OK73120

[email protected] Contact: Cecylia Phone: (405) 748-4700 Fax: (405) 748-5638

physiatry - head, neck, spine upper and lower extremities, nerve and joint problems

Oklahoma City

Excl. Body Parts/Svcs: narcotic pain management, RSD American Academy of Physical Medicine/Rehab TR

Physical Medicine and Rehabilitation

A. E. Moorad, M.D.*

4221 S Western Ste 3010 Oklahoma City, OK73109

all PM & R, pain managment

Contact: Marilyn Phone: (405) 636-7450 Fax: (405) 631-2296 American Board of Internal Medicine T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 71

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Physical Medicine and Rehabilitation

Darryl Dermot Robinson, M.D.

3110 SW 89 Ste 102 Oklahoma City, OK73159

all within speciality

[email protected] Contact: Lindsey Phone: (405) 703-4950 Fax: (405) 703-4955

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: None American Board of Physical Medicine and Rehab-Pain Management T R MITF

Physical Medicine and Rehabilitation

Kathleen M. Sisler, M.D.

6585 S Yale Ave Ste 200 Tulsa, OK74136

[email protected] Contact: Allison Phone: (918) 481-2767 Fax: (918) 481-7669

elbows, hands, knees, hips, neck, spine, feet, ankles, wrists, shoulders (Physiatry)

Tulsa

Excl. Body Parts/Svcs: none American Board of Physical Medicine/Rehabilitation T R MITF

Physical Medicine and Rehabilitation

Michael Shawn Smith, M.D.

5100 N Brookline Ste 500 Oklahoma City, OK73112

PM&R, spine, spinal cord and brain injuries

[email protected] Contact: Alecia Phone: (405) 605-8780 Fax: (405) 605-8782 American Board of Physical Medicine/Rehabilitation T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

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Page: 72

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Physical Medicine and Rehabilitation

Jonathan B. Stone, D.O.

700 NW 7 Street Ste 115 Oklahoma City, OK73102

all within speciality chronic medication management, continuing medical maintenance

Oklahoma City

[email protected] Contact: Sarah Phone: (405) 601-5899 Fax: (405) 601-5903

American Board of Physical Medicine and Rehabilitation T Physical Medicine and Rehabilitation

D. Brent Tipton, M.D.

5100 N Brookline Ste 530 Oklahoma City, OK73112

[email protected] Contact: Linda Phone: (405) 604-6652 Fax: (405) 604-6653

muscles and nerves

Oklahoma City

Excl. Body Parts/Svcs: heart, lungs, GI, Renal, medical maintenance, pain management American Board of Physical Medicine/Rehabilitation/Electrodiag nos TR

Plastic Surgery

Mehdi N. Adham, M.D.* Contact: Alice Phone: (405) 632-4468 Fax: (405) 632-4317

8100 S Walker Ave Bldg A Oklahoma City, OK73139

plastic & reconstructive surgery of hands and wrists Excl. Body Parts/Svcs: all except plastic surgery of hands/wrists American Board of Plastic Surgery & Am Bd Plastic Surg of Hand T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 73

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Plastic Surgery

Paul David Hunter, M.D.*

535 NW 9th Street #300 Oklahoma City, OK73102

Ears, nose, throat and facial trauma

[email protected] Contact: Dianne Hunter Phone: (405) 272-6027 Fax: (405) 272-8315

City of Exam

Oklahoma City

Excl. Body Parts/Svcs: all others but listed AM Board of Otolaryngology T

Podiatry

Armando A. Carro, D.P.M.

600 W 15 St Edmond, OK73013

[email protected] Contact: Phone: (405) 348-4141 Fax: (405) 340-0686

foot, ankle

Edmond and Shawnee

Excl. Body Parts/Svcs: None Certification Unknown T

Podiatry

David C. Cavallaro, D.P.M. [email protected] Contact: Brandie Phone: (405) 631-4263 Fax: (405) 616-2670

1044 SW 44 floor 6 Oklahoma City, OK73109

feet, ankles and related structures Excl. Body Parts/Svcs: Upper Body American Board of Podiatric Surgery T

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

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Page: 74

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Podiatry

Timothy Siegfried, D.P.M.

10229 E 96 Street North Ste 100 Owasso, OK74055

foot, ankle

[email protected] Contact: Melissa Phone: (918) 494-2902 Fax: (918) 272-8922

City of Exam

Owasso

Excl. Body Parts/Svcs: none within specialty American Board of Podiatric Surgery T R MITF

Podiatry

William K. Smith, D.P.M.

1627 N Kickapoo Shawnee, OK74804

Foot and Ankle

Shawnee, Oklahoma City

[email protected] Contact: Crissy,275-8234 Lori4059437797 Phone: (405) 275-8234 Fax: (405) 275-7298 American Board of Podiatric Surgery T R MITF Podiatry

Richard J Traczyk, II, D.P.M.

4205 McAuley Blvd Ste 465 Oklahoma City, OK73120

[email protected] Contact: Lanae Phone: (405) 755-7600 Fax: (405) 755-7680

foot, ankle

Oklahoma City

Excl. Body Parts/Svcs: anything above the ankle and ankle surgery Certification Unknown T R MITF

Psychiatry

Dominic Losacco, M.D.

6565 S Yale Ave Ste 706 Tulsa, OK74136-8308

all within psychiatric specialty

Contact: Mary, Mitzie Phone: (918) 491-5767 Fax: (918) 491-5771 American Board of Psychiatry and Neurology * Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 75

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Psychiatry

Siavash Nael, M.D.

4720 S Western Ave Oklahoma City, OK73109-3834

psychiatry

Oklahoma City

[email protected] Contact: any staff member Phone: (405) 634-5529 Fax: (405) 634-1673 American Board of Pyschiatry and Neurology T Psychology - Clinical

Russell L. Adams, Ph.D.*

PO Box 26901 WP3440 Oklahoma City, OK73126

brain, pain management, psychological overlay

Oklahoma City

Contact: Gary Phone: (405) 271-8001 Fax: (405) 271-8802 American Board of Professional Psychology/Clinical Neuropsych TR Psychology - Clinical

Faust Bianco, Jr., Ph.D.*

Contact: Suzan Phone: (918) 746-0794 Fax: (918) 746-0717

7146 S Braden Ave Ste 500 Tulsa, OK74136

Rehabilitation (nervous system, whole body) Trauma Related Disorders (pain stress, depression, brain) Excl. Body Parts/Svcs: none Certification Unknown T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 76

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Psychology - Clinical

Douglas O. Brady, Ph.D.*

1401 SW Park Ridge Blvd Ste D Lawton, OK73505

Brain; Back (Spine); Chronic pain issues multiple sites

City of Exam

Lawton

[email protected] Contact: D'Ann Smith Phone: (580) 355-7474 Fax: (580) 355-6765 American Board of Professional Disability T R MITF Psychology - Clinical

R. Keith Green, Ph.D.

5929 N May Ave Ste 508 Oklahoma City, OK73112

[email protected] Contact: Virginia Green Phone: (405) 842-6446 Fax: (405) 842-5644

psychological evaluations and therapy

Oklahoma City

Excl. Body Parts/Svcs: None Certification Unknown T

Psychology - Clinical

David E. Johnsen, Ph.D. [email protected] Contact: Lea or Angela Phone: (405) 755-8576 Fax: (405) 755-6026

2601 NW Expway Ste 410 W Oklahoma City, OK73112

psychological overlay, chronic pain, neuropsychology Excl. Body Parts/Svcs: None Certification Unknown TR

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 77

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Psychology - Clinical

Edgar J. Kranau, Ph.D.*

PO Box 14082 Tulsa, OK74159-4082

psychological overlay, pain management

Tulsa

[email protected] Contact: self Phone: (918) 712-9020 Fax: (918) 712-9021

Excl. Body Parts/Svcs: None Certification Unknown T R MITF

Psychology - Clinical

Doris Wise, Ph.D. [email protected] Contact: Debbie Phone: (405) 286-6000 Fax: ( )

P.O. Box 60847 Oklahoma City, OK73146

psychological: mood, coping, adjustment, rehab

Oklahoma City

Excl. Body Parts/Svcs: none

-

Certification Unknown T Psychology

Michael R. Basso, Ph.D.* [email protected] Contact: Dr. Basso Phone: (918) 631-3151 Fax: (918) 631-2833

Univ of Tulsa Dept of Psychology 800 S Tucker Drive Tulsa, OK74104

head/brain - diatnostic testing, psychological overlay Excl. Body Parts/Svcs: None ABPP - Clinical Neuropsychology R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 78

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

Psychology

Stephen D. Carella, Ph.D.

3035 NW 63 Ste 103 Oklahoma City, OK73116

psychological overlay

City of Exam

Oklahoma City

[email protected] Contact: Sue Phone: (405) 840-4212 Fax: (405) 840-4258 Certification Unknown T R MITF Psychology

Edgar J. Kranau, Ph.D.*

PO Box 14082 Tulsa, OK74159-4082

[email protected] Contact: self Phone: (918) 712-9020 Fax: (918) 712-9021

psychological overlay, pain management

Tulsa

Excl. Body Parts/Svcs: None Certification Unknown T R MITF

Pulmonary Diseases

Dennis M. Parker, M.D.

Contact: Lisa Burgess 405-947-3345 Phone: (405) 917-5439 Fax: (405) 494-0849

3366 NW Expressway Ste 660 Oklahoma City, OK73112

pulmonary (lungs) Excl. Body Parts/Svcs: all except respiratory disease American Board of Internal Medicine, Am Bd - Pulmonary Disease T R MITF

* Physician has multiple specialties.

Oklahoma City

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 79

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Sports Medicine

Gary B. Anderson, M.D.*

3301 NW 50 St Oklahoma City, OK73112

knees, shoulders, hips, elbows

Oklahoma City

[email protected] Contact: Scheduling Phone: (405) 947-0911 Fax: (405) 947-0775

Excl. Body Parts/Svcs: spine (back, neck), hands American Board of Orthopedic Surgery T R MITF

Sports Medicine

Clint Justin Basener, D.O.*

9709 E 79 Street S Tulsa, OK74133-4566

[email protected] Contact: Pam Phone: (918) 994-4068 Fax: (918) 994-4095

all within specialty

Tulsa

Excl. Body Parts/Svcs: All except brain, neck, spine Certification Unknown TR

Sports Medicine

Darnell E. Blackmon, M.D.*

Contact: Rae Phone: (918) 582-6800 Fax: (918) 582-6060

1809 E 13 Ste 100 Tulsa, OK74104

Sports Medicine, Food and Ankle Excl. Body Parts/Svcs: spine, hand American Board of Orthopaedic Surgery TR

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 80

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Sports Medicine

Bradford Boone, M.D.*

6475 S Yale Ave Ste 301 Tulsa, OK74136-7824

knees, shoulders, elbows

Tulsa

[email protected] Contact: Wendy Phone: (918) 494-9300 Fax: (918) 494-9397

Excl. Body Parts/Svcs: spine, hips, feet, ankles, hands & rate only cases American Board of Orthopedic Surgery/Sports Medicine TR

Sports Medicine

James D. Cash, M.D.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

[email protected] Contact: Phone: (918) 481-2767 Fax: (918) 481-7611

knees, shoulders

Tulsa

Excl. Body Parts/Svcs: none American Board of Orthopedic Surgery T R MITF

Sports Medicine

Jeff A. Fox, M.D.*

Contact: appt desk Phone: (918) 481-7658 Fax: (918) 481-7611

6585 S Yale Ave Ste 200 Tulsa, OK74136

knees, ankles, elbow, shoulders Excl. Body Parts/Svcs: hand, spine American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 81

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Sports Medicine

Troy A. Glaser, D.O.

6585 S Yale Ave Ste 200 Tulsa, OK74136

spine, knees, ankles, shoulders & foot

Tulsa

[email protected] Contact: Appt Desk Phone: (918) 481-7658 Fax: (918) 481-7611

Excl. Body Parts/Svcs: tailbone American Board of Family Medicine T R MITF

Sports Medicine

Bryan Hawkins, M.D.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

[email protected] Contact: CSOS Phone: (918) 481-2767 Fax: (918) 481-7611

ankles, knees, feet, hip

Tulsa

Excl. Body Parts/Svcs: neck, spine, wrists, hands, elbows American Board of Orthopedic Surgery T R MITF

Sports Medicine

Ronald S. LaButti, D.O.* [email protected] Contact: appt desk Phone: (918) 481-2767 Fax: (918) 481-7611

6585 S Yale Ave Ste 200 Tulsa, OK74136

hips, knees, ankles, foot Excl. Body Parts/Svcs: hand, elbow, arms, shoulders American Osteopathic Aacademy of Orthopedics T R MITF

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 82

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Sports Medicine

Jason M. Leinen, M.D.*

3115 SW 89 Street Oklahoma City, OK73159

all family & sports medicine, pain management (evaluate all body parts)

Oklahoma City

[email protected] Contact: Amy Phone: (405) 600-1411 Fax: (405) 600-1531

Excl. Body Parts/Svcs: none American Board of Family Medicine T

Sports Medicine

Jeffrey R. Morris, D.O.*

6585 S. Yale Ave Suite 200 Tulsa, OK74136

[email protected] Contact: Reggie 918-583-7076 Phone: (918) 481-2767 Fax: (918) 583-7908

shoulder, hand, wrist, hip, knee, ankles & total joint replacements

Tulsa

Excl. Body Parts/Svcs: neck, spine American Osteopathic Board of Orthopedfic Surgery T R MITF

Sports Medicine

Victor R. Palomino, D.O.* [email protected] Contact: Rae Phone: (918) 582-6800 Fax: ( )

1809 E 13 St Ste 100 Tulsa, OK74104

Orthopedics; Sports Medicine Excl. Body Parts/Svcs: Back, Foot/ankle, hand

American Osteopathic Board T

* Physician has multiple specialties.

Tulsa

Date: 01/19/2017 Time: 08:45

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP (Alphabetical by Specialty) As of January 1, 2017

Page: 83

Specialty

Physician/Contact Info

Mailing Address

Body Parts/Type of Services/ Board Certified

City of Exam

Sports Medicine

R. Clio Robertson, M.D.*

6585 S Yale Ave Ste 200 Tulsa, OK74136

neck, spine, shoulder, elbows, wrists, hips, knees, ankles

Tulsa

[email protected] Contact: Phone: (918) 481-2767 Fax: (918) 481-7611 American Board of Orthopedic Surgery T R MITF

* Physician has multiple specialties.

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