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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 14:36 (Alphabetical by Specialty) Page: 1 As of January 1, 2014 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology Ahmed Amayem, M.D. 1145 SW 74 St, Bldg I Ste 100 pain management Oklahoma City Oklahoma City, OK73139 Excl. Body Parts/Svcs: Contact: Melissa head injuries, abdominal pain, complicated multi organ medical Phone: (405) 632-1783 Fax: ( ) - cases American Board of Anesthesiology T Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts Tulsa Tulsa, OK74132-1823 [email protected] Excl. Body Parts/Svcs: Contact: Jan None Phone: (918) 513-3226 Fax: (918) 447-9308 American Board of Anesthesiology T Anesthesiology Grigory Chernyak, M.D. 105 S Bryant Ste 404 pain management Edmond Edmond, OK73034 gregory [email protected] Excl. Body Parts/Svcs: Contact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician has multiple specialties.

LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

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Page 1: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 1

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Ahmed Amayem, M.D. 1145 SW 74 St, Bldg I Ste 100 pain management Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Melissa head injuries, abdominal pain,

complicated multi organ medicalPhone: (405) 632-1783 Fax: ( ) -cases

American Board of AnesthesiologyT

Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts TulsaTulsa, OK74132-1823

[email protected] Excl. Body Parts/Svcs:Contact: Jan NonePhone: (918) 513-3226 Fax: (918) 447-9308

American Board of AnesthesiologyT

Anesthesiology Grigory Chernyak, M.D. 105 S Bryant Ste 404 pain management EdmondEdmond, OK73034

gregory [email protected] Excl. Body Parts/Svcs:Contact: Marce all except specialtyPhone: (405) 431-0804 Fax: ( ) -

American Board of AnesthesiologyT

* Physician has multiple specialties.

Page 2: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 2

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Richard A. DuBose, M.D. 2000 S Wheeling Ave Ste 600 all pain management TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: Pat all except pain managementPhone: (918) 742-7030 Fax: (918) 745-6284

American Board of AnesthesiologyT

Anesthesiology David P. Ellis, M.D. 701 NE 10 Street pain management/interventional pain Oklahoma Citymedicine/spinal cord stimulatorsOklahoma City, OK73104Excl. Body Parts/Svcs:Contact: JenniferheadachePhone: (405) 232-8003 Fax: ( ) -

American Board of Anesthesiology -Pain Medicine

T R MITF

Anesthesiology Terry M. Gile, D.O. 3204 W Okmulgee all pain management MuskogeeMuskogee, OK74401

Excl. Body Parts/Svcs:Contact: Pat all except pain managementPhone: (918) 742-7030 Fax: ( ) -

Am Osteopathic Board ofAnesthesiology/Pain Mngmt

T

* Physician has multiple specialties.

Page 3: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 3

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Frank J. Hackl, M.D. 2448 E 81 Street ste 363 Pain Management TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Angie female health issuesPhone: (918) 477-5950 Fax: (918) 447-5951

American Board of Anesthesiology -Pain Medicine

T

Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Brenda all except pain management casesPhone: (918) 477-5943 Fax: ( ) -

American Osteopathic Board ofAnesthesiology & Pain Management

T

Anesthesiology Martin L. Martucci, M.D. 2000 S Wheeling Ste 600 pain management TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: Jamie None within specialtyPhone: (918) 742-7030 Fax: (918) 742-9958

American Board of AnesthesiologyT

* Physician has multiple specialties.

Page 4: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 4

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Daniel G. Morris, D.O.* 2811 E 15 Street Ste 102 Pain Management Only TulsaTulsa, OK74104

okpainandwellness.comContact: schedulingPhone: (918) 935-3240 Fax: (918) 935-3241

American Osteopathic Board ofAnesthesiology-Pain Management

T R MITF

Anesthesiology Michael Chad Owens, D.O. 427 E Cherokee Interventional Pain Management Enid(total body)Enid, OK73701

Contact: BarbaraPhone: (580) 234-7246 Fax: ( ) -

American Board of AnesthesiologyT

Anesthesiology Jayen H. Patel, M.D. 2811 E 15 Street Ste 102 pain management (neck, back, leg, Tulsahand headaches, RSD)Tulsa, OK 7410-4

www.okpainandwellness.comExcl. Body Parts/Svcs:Contact: appt deskeye, foot, pelvis, elbow, rist,Phone: (918) 935-3240 Fax: (918) 935-3241brain, ear

American Board of AnesthesiologyT

* Physician has multiple specialties.

Page 5: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 5

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Terrell, R. Phillips, D.O. 401 SW 80 Street Ste 101 Pain Management Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Tammy none within specialtyPhone: (405) 601-4227 Fax: (405) 601-4237

American Osteopathic Board ofAnesthesiology

T R MITF

Anesthesiology Justin Porter, M.D. 3601 NW 138 Street Ste 200 Pain Management Oklahoma CityOklahoma City, OK73134

[email protected] Excl. Body Parts/Svcs:Contact: Neile pelvic pain, vaginal pain, rectal

painPhone: (405) 242-4100 Fax: (405) 775-9356

Certification UnknownT R MITF

Anesthesiology Andreas "Andrew" Revelis, M.D. 2000 S Wheeling Ave Ste 600 pain management TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: Pat NonePhone: (918) 742-7030 Fax: (918) 742-9958

Certification UnknownT

* Physician has multiple specialties.

Page 6: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 6

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Kalvin L. White, D.O. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK74132-1823

[email protected]: AngeliaPhone: (918) 513-3231 Fax: (918) 447-9308

Am Board of AnesiologyT

Anesthesiology Traci L. White, M.D. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK73132-1923

Contact: BuffyPhone: (918) 513-3225 Fax: (918) 447-9308

American Board ofAnesthesiology/Pain Medicine

T

Chiropractic Thomas Cate, D.C. 2828 E 51 Ste 103 neck, full spine, extremities TulsaTulsa, OK74105

Excl. Body Parts/Svcs:Contact: Dulcy nonePhone: (918) 747-2225 Fax: ( ) -

Certification UnknownT R

Chiropractic Michael A. Chiaffitelli, D.C. 10001 S Penn Bldg P Ste 170 all chiropractics - spine, Oklahoma CityextremitiesOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: Alishainternal organsPhone: (405) 681-2273 Fax: (405) 681-2274

Certification UnknownT R

* Physician has multiple specialties.

Page 7: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 7

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Chiropractic Craig A. Day, D.C. 3023 S HARVARD back TulsaTULSA, OK74114

Contact: SELFPhone: (918) 742-2094 Fax: ( ) -

Certification UnknownT

Chiropractic Lance B. Goodwin, D.C. PO Box 172 spine CatoosaCatoosa, OK74015

Excl. Body Parts/Svcs:Contact: Whitney, Nicolel NonePhone: (918) 266-6000 Fax: ( ) -

Certification UnknownT

Chiropractic Edward C. Holmes, D.C. 1400 S Fretz Ave Ste 130 cervical, thoracic, lumbar, sacrum, Edmondpelvis, upper extremities, lowerEdmond, [email protected]

Contact: selfExcl. Body Parts/Svcs:Phone: (405) 285-1429 Fax: ( ) -none

National Board of ChiropracticExaminers

T R MITF

* Physician has multiple specialties.

Page 8: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 8

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Chiropractic Seyoung Kim, D.C. 5583 NW Expressway spine (neck, back), hand Oklahoma CityOklahoma City, OK73132

Excl. Body Parts/Svcs:Contact: Jennifer NonePhone: (405) 773-3131 Fax: (405) 773-4267

Certification UnknownT R

Chiropractic Hugh G. McClure, D.C. 401 Vandament Ave Ste 102 whole body Yukon, OklahomaCityYukon, OK73099

hugh @ hgmcclure.com Excl. Body Parts/Svcs:Contact: Amy NonePhone: (405) 350-7283 Fax: (405) 354-7802

Certification Unknown R MITF

Chiropractic C. Keith Muse, D.C. 6825 S Western Ave neuromusculoskeletal Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Peggy NonePhone: (405) 634-1127 Fax: ( ) -

Certification UnknownT R MITF

Chiropractic Jim R. Muse, D.C. 6825 S Western spine Oklahoma CityOklahoma City, OK73139

Contact: Ann, PeggyPhone: (405) 634-1127 Fax: (405) 634-1177

Certification UnknownT R

* Physician has multiple specialties.

Page 9: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 9

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Chiropractic James Daniel Post, D.C. 4141 NW Expressway Ste 180 all chiropractics-spine Oklahoma CityOklahoma City, OK73116

[email protected]: Rhonda, CathyPhone: (405) 840-8900 Fax: (405) 840-8990

Certification UnknownT

Chiropractic Keith G. Ryan, D.C. 3319 E 46 St Ste 101 back and extremities TulsaTulsa, OK74135-2903

[email protected] Excl. Body Parts/Svcs:Contact: Dr. Ryan NonePhone: (918) 742-6262 Fax: (918) 742-7152

Certification UnknownT R MITF

Chiropractic Troy A. Sturgill, D.C. PO Box 335 musculoskeletal WoodwardWoodward, OK73802

Excl. Body Parts/Svcs:Contact: self brain, heart, lungs, visionPhone: (580) 256-1555 Fax: (580) 256-3370

Certification UnknownT R

Chiropractic Ronald B. Tripp, D.C. 2400 Tee Circle all within specialty NormanNorman, OK73069

[email protected] Excl. Body Parts/Svcs:Contact: Sherri nonePhone: (405) 321-8530 Fax: (405) 321-1478

Certification UnknownT R

* Physician has multiple specialties.

Page 10: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 10

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Chiropractic David B. Waggoner, D.C. 7000 NW Expressway Ste H chiropractic Oklahoma CityOklahoma City, OK73132

Excl. Body Parts/Svcs:Contact: Meaghan non-musculoskeletalPhone: (405) 773-1113 Fax: ( ) -

Certification UnknownT R

Dentistry Melvin Burnitt Baker, Jr., D.D.S. 7405 NW 23 St general dentistry BethanyBethany, OK73008

Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 787-5266 Fax: ( ) -

Certification Unknown

Dentistry Larry S. Baker, D.D.S. 2616 W I-44 Service Rd mouth;, teeth, temporomandibular Oklahoma CityjointsOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Maryanything not dentally relatedPhone: (405) 943-3575 Fax: ( ) -

Certification UnknownT R MITF

Dentistry Bryan Chrz, D.D.S. 505 N 14 St all dental PerryPerry, OK73077

Contact: ShelleyPhone: (580) 336-2255 Fax: (580) 236-0362

American Board of ForensicOdonyology

T R MITF

* Physician has multiple specialties.

Page 11: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 11

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Dentistry Emile M. Farha, D.D.S. 1316 NW 150 Terrace general dentistry/oral diagnosis EdmondOklahoma City, OK73013

Contact: selfPhone: (405) 348-9911 Fax: ( ) -

Certification UnknownT

Dentistry Steven W. Hogg, D.D.S. 423 W Washington St mouth, teeth Broken ArrowBroken Arrow, OK74012

[email protected] Excl. Body Parts/Svcs:Contact: Beth NonePhone: (918) 455-8899 Fax: (918) 362-9997

Certification UnknownT R MITF

Dentistry Sterling H. Stalder, D.D.S 930 SW 107 Street dentistry Oklahoma CityOklahoma City, OK73170

[email protected] Excl. Body Parts/Svcs:Contact: Renee nonePhone: (405) 634-7303 Fax: (405) 634-7868

Certification UnknownT

Family Medicine Thomas Carlile, D.O. 3916 S Sunnylane Road all body parts Del CityDel City, OK73115

Excl. Body Parts/Svcs:Contact: Lisa eyesPhone: (405) 677-3378 Fax: ( ) -

American College Osteopathic FamilyPhysicians

T R

* Physician has multiple specialties.

Page 12: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 12

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Family Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 head, neck, back, extremities, Oklahoma Citylungs, toxicologyOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: KellyheartPhone: (405) 917-5336 Fax: (405) 917-2250

American Board of Family MedicineT R MITF

Family Medicine Graciela C. Gallardo, M.D. 5101 W Memorial pain management Oklahoma CityOklahoma City, OK73142

Contact: TracyPhone: (405) 752-9600 Fax: ( ) -

American Board of Family MedicineT

Family Medicine Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195

American Board of Family Medicine -Sports Medicine

T R MITF

Family Medicine Jason M. Leinen, M.D.* 3115 SW 89 Street all family & sports medicine Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 600-1411 Fax: (405) 600-1531

American Board of Family MedicineT

* Physician has multiple specialties.

Page 13: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 13

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Family Medicine Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, Shawneephysical medicine andOklahoma City, [email protected]

Contact: Kendra, BrittanyExcl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial

American Board of Family Medicine &Sports Medicin

T

Family Medicine Michael L. Winzenread, M.D. 105 S Broadway Ste 408 all EdmondEdmond, OK73034

Excl. Body Parts/Svcs:Contact: NonePhone: (405) 816-6840 Fax: ( ) -

American Board of Family Practice R MITF

Family Practice T. Jeffrey Emel, M.D.* 6475 S Yale Ave Ste 301 all TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of FamilyPractice/Sports Medicine

T R

* Physician has multiple specialties.

Page 14: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 14

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Family Practice Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195

American Board of Family Medicine -Sports Medicine

T R MITF

Family Practice Daniel G. Morris, D.O.* 2811 E 15 Street Ste 102 Pain Management Only TulsaTulsa, OK74104

okpainandwellness.comContact: schedulingPhone: (918) 935-3240 Fax: (918) 935-3241

American Osteopathic Board ofAnesthesiology-Pain Management

T R MITF

Family Practice Lance E. Rosson, D.O. 1211 N Shartel Ste 1104 all Oklahoma CityOklahoma City, OK73103

Excl. Body Parts/Svcs:Contact: Sharon NonePhone: (405) 236-1900 Fax: (405) 236-0362

American Board of Family PhysiciansT R MITF

* Physician has multiple specialties.

Page 15: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 15

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

General Surgery Christopher D. Carey, M.D. 3400 NW Expressway Ste 420 specialty only Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Sharon all except specialtyPhone: (405) 713-9935 Fax: (405) 713-9936

American Board of SurgeryT

General Surgery Russell L. Hanan, Jr., M.D. 608 NW 9 STE 4204 general surgery Oklahoma CityOklahoma City, OK73102

Excl. Body Parts/Svcs:Contact: Peggy, Christina head, spine, orthopedicPhone: (405) 235-3245 Fax: (405) 235-6991

Certification UnknownT

General Surgery Ned D. Hemric, Jr., M.D. 3435 NW 56 Street Ste 707 OKCOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Jessica back painPhone: (405) 601-0300 Fax: (405) 601-0303

AMERICAN BOARD OF SURGERYT

* Physician has multiple specialties.

Page 16: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 16

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists

American Board of Plastic Surgery &Am Bd Plastic Surg of Hand

T R MITF

Hand Surgery James F. Bischoff, M.D.* 6475 S Yale Ave Ste 301 hands, wrists TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda spine, elbows, shoulders, feet,

ankles, knees, hips, rate onlyPhone: (918) 494-5520 Fax: (918) 494-9397cases

American Board of OrthopedicSurgery

T R

Hand Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 upper extremities (shoulder down to Tulsafingers)Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Raeknees, back, neck, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293

American Osteopathic Board ofOrthopedic Surgery

T R

* Physician has multiple specialties.

Page 17: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 17

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Michael B. Clendenin, M.D. 2000 S Wheeling Ste 900 hands and wrists only TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: BJ all except hands and wristsPhone: (918) 749-1418 Fax: (918) 749-6241

American Board of OrthopedicSurgery

T R

Hand Surgery Tom W. Ewing, D.O. 1020 24 Ave NW Ste 100 hands NormanNorman, OK73069

[email protected] Excl. Body Parts/Svcs:Contact: Melissa all except handsPhone: (405) 447-4999 Fax: (405) 447-5608

American Osteopathic Board ofOrthopedic Surgery

T R

Hand Surgery Joel L. Frazier, M.D.* 1044 SW 44 St Ste 600 hands, upper extremities, elbows, Oklahoma CitywristsOklahoma City, OK73109Excl. Body Parts/Svcs:Contact: Stephanieall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

Page 18: LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS ... Specialty Listing.pdfContact: Marce all except specialty Phone: (405) 431-0804 Fax: ( ) - American Board of Anesthesiology T * Physician

Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 18

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Charles H. Funderburk, M.D.* 1110 N Lee hands, shoulders, elbows, knees, Edmond,wrists, forearm Oklahoma CtiyOklahoma City, OK73103-2612

[email protected]. Body Parts/Svcs:Contact: neck, back, hips, feetPhone: (405) 230-9743 Fax: (405) 522-9474

American Board of OrthopedicSurgery

T R

Hand Surgery Greg Halko, M.D.* 3301 NW 50 hands, upper extremities Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) and lower

extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopedicSurgery

T R MITF

Hand Surgery Daron C. Hitt, M.D. 3115 SW 89 Street hands only Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 424-5630 Fax: (405) 692-1632

American Board of SurgeryT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 19

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Thomas C. Howard, M.D.* 1110 N Lee hands, shoulders, knees, hips and Oklahoma City,feet NormanOklahoma City, OK73103-2612

[email protected]. Body Parts/Svcs:Contact: schedulingspine, (neck,back)Phone: (405) 230-9752 Fax: (405) 230-9424

American Board of OrthopedicSurgery

T R

Hand Surgery Stephen W. Mihalsky, M.D. 105 S Bryant Ste 407 all within specialty Midwest City,EdmondEdmond, OK73034

Excl. Body Parts/Svcs:Contact: Donna Elswick shoulders, neckPhone: (405) 348-5060 Fax: (405) 364-8750

American Board of Surgery of theHand, American Board of Surgery

T R MITF

Hand Surgery David B. Mokhtee, M.D. 9709 E 79th Street S hand surgery only TulsaTulsa, OK74133-4566

Excl. Body Parts/Svcs:Contact: Pam all expcept handsPhone: (918) 994-4068 Fax: (918) 994-4095

American Board of Surgery - HandSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 20

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery M. Sean O'Brien, D.O.* PO Box 890358 hands only Oklahoma CityOklahoma City, OK73189

Excl. Body Parts/Svcs:Contact: Cindy Burditt back, neck, feetPhone: (405) 759-2663 Fax: ( ) -

American Osteopathic Board ofOrthopedic Surgery

T

Hand Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand Oklahoma CityOklahoma City, OK73112-4418

Excl. Body Parts/Svcs:Contact: back and lower extremitiesPhone: (405) 945-4888 Fax: (405) 945-4887

American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand

T R

Hand Surgery Richard A. Ruffin, M.D.* 3301 NW 50 hands, wrists, elbows, shoulders Oklahoma CityOklahoma City, OK73112-5691

Excl. Body Parts/Svcs:Contact: Central Scheduling neck, back, feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263

American Board of OrthopedicSurgery, Hand Surgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 21

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Houshang Seradge, M.D.* 1044 SW 44 Street Ste 600 hands, wrists Oklahoma CityOklahoma City, OK73109-8121

Excl. Body Parts/Svcs:Contact: Denise all except hands & wristsPhone: (405) 631-4263 Fax: (405) 631-1767

American Board of OrthopedicSurgery

T R MITF

Hand Surgery Garrett Watts, M.D. 2950 S Elm Pl Ste 456 hands, wrists Broken ArrowBroken Arrow, OK74012

Excl. Body Parts/Svcs:Contact: Francine, Ashley backPhone: (918) 451-3000 Fax: (918) 451-2700

American Board of OrthopedicSurgery

T R MITF

Internal Medicine S.A. Chaudry, M.D. 5611 Mosteller Dr all internal medicine - whole body Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Cheryl NonePhone: (405) 843-2345 Fax: (405) 843-8237

American Board of Internal MedicineT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 22

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Internal Medicine Richard Allen Hastings, II, D.O. 1851 E 71 Street all TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Kari, Andrea NonePhone: (918) 749-1720 Fax: (918) 746-0674

American College of OsteopathicInternists

T R MITF

Internal Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131

Excl. Body Parts/Svcs:Contact: Yvonne, Leslie psychiatricPhone: (405) 840-6720 Fax: (405) 840-6723

American Board of Internal Medicine R MITF

Internal Medicine A. E. Moorad, M.D.* 4221 S Western Ste 3010 all PM & R, pain managment Oklahoma CityOklahoma City, OK73109

Contact: MarilynPhone: (405) 636-7450 Fax: (405) 631-2296

American Board of Internal MedicineT R MITF

Internal Medicine Venkatesh Movva, M.D.* 6565 S Yale Ste 212 pain management TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Michelle migrainesPhone: (918) 502-4008 Fax: (918) 502-4001

American Board of Internal MedicineT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 23

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Internal Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107

Excl. Body Parts/Svcs:Contact: Rhonda nonePhone: (918) 742-4881 Fax: (918) 742-5854

Internal MedicineT R MITF

Internal Medicine Sidney Williams, M.D. 801 South Washington Street Internal Medicine/Pain Management StillwaterStillwater, OK74074

Excl. Body Parts/Svcs:Contact: headachesPhone: (405) 377-1121 Fax: (405) 624-9201

Certification UnknownT

Neurology Ellen E. Hope, M.D. 14100 Parkway Comons Dr Ste 102 head, neck, back, extremities, Oklahoma Cityspinal cordOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: ChristineNonePhone: (405) 270-0500 Fax: (405) 270-0597

American Board of Psychiatry andNeurology

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 24

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurology Howard R. Jarrell, M.D. 14100 Parkway Commons Dr Ste 103 spine, radiculopathy, EMG Oklahoma CityOklahoma City, OK73134

None Excl. Body Parts/Svcs:Contact: Kerri head, general neurologyPhone: (405) 841-1111 Fax: (405) 840-8380

American Board of Psychiatry andNeurology

T

Neurology Jay K. Johnson, D.O. 7134 S Yale Ave Ste 450 all within specialty TulsaTulsa, OK74136-6380

www.tulsaneuro.com Excl. Body Parts/Svcs:Contact: Jennifer, Adair all except specialtyPhone: (918) 743-2882 Fax: (918) 745-0323

American Osteopathic Board ofPsychiatry and Neurology

T

Neurology Douglas W. Kaplan, M.D. 4120 W Memorial Rd Ste 204 brain, spine, peripherel nerves Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Amanda all except neurological casesPhone: (405) 749-4270 Fax: (405) 749-4277

American Board of Psychiatry andNeurology

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 25

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurology Gabriel Pitman, D.O. 401 SW 80 STE 201 all within neurology specialty Oklahoma CityOklahoma City, OK73139

[email protected] Excl. Body Parts/Svcs:Contact: Kandice abdomen, chestPhone: (405) 632-9090 Fax: ( ) -

American Board of NeurologyT

Neurology W. Dean Shipley, M.D. 4120 W Memorial Rd Ste 218 nervous system only/adult nerology Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Kelly neuological IME's onlyPhone: (405) 302-2661 Fax: (405) 302-2670

American Board of Psychiatry andNeurology

T

Neuropsychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126

Contact: DemareePhone: (405) 271-8001 Fax: (405) 271-8802

American Board of ProfessionalPsychology/Clinical Neuropsych

R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 26

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neuropsychology - Clinical Michael R. Basso, Ph.D.* Univ of Tulsa Dept of Psychology head/brain - diatnostic testing, Tulsapsychological overlay800 S Tucker Drive

[email protected] Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Dr. BassoNonePhone: (918) 631-3151 Fax: (918) 631-2833

ABPP - Clinical Neuropsychology R MITF

Neuropsychology - Clinical James G. Scott, Ph.D.* PO Box 26901 brain/emotions Oklahoma CityOklahoma City, OK73126-0901

Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 271-5253 Fax: (405) 271-5759

American Board of ProfessionalPsychology

T R MITF

Neuropsychology Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehabilitation (nervous system, Tulsawhole body) Trauma RelatedTulsa, OK74136Disorders (pain stress, depression,brain)Contact: Suzan

Phone: (918) 746-0794 Fax: ( ) -Excl. Body Parts/Svcs:none

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 27

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neuropsychology Douglas O. Brady, Ph.D.* 1401 SW Park Ridge Blvd Ste D medical psychology, neuropsychology LawtonevaluationsLawton, OK73505

[email protected]: D'AnnPhone: (580) 355-7474 Fax: (580) 355-6765

American Board of ProfessionalDisability

T R MITF

Neuropsychology David E. Hansen, Ph.D. 5512 S Lewis Ave Ste 8 neuropsychology/brain TulsaTulsa, OK74105

Excl. Body Parts/Svcs:Contact: Emge NonePhone: (918) 712-9004 Fax: (918) 712-9120

Certification Unknown R MITF

Neuropsychology Mickey S. Ozolins, Ph.D. 4140 W Memorial Rd Ste 601 brain Oklahoma CityOklahoma City, OK73120

[email protected]: SherriPhone: (405) 749-2870 Fax: (405) 749-2858

American Board of ProfessionalPsychology

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 28

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neuropsychology Terry G. Shaw, Ph.D. 7146 S Braden Ste 500 head, brain, psychological overlay TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Mary NonePhone: (918) 488-6165 Fax: (918) 488-8021

American Board of ProfessionalNeuropsychology

R

Neuropsychology Adam G. Sherman, Ph.D. 3015 E Skelly Dr Ste 135 all within specialty TulsaTulsa, OK74105

Excl. Body Parts/Svcs:Contact: Susan NonePhone: (918) 712-2885 Fax: (918) 712-9019

Certification UnknownT R

Neurosurgery Clinton J. Baird, M.D. 6802 S Olympia Ave Ste 350 spine, brain, nerves, carpal Tulsatunnel, ulnar nerveTulsa, OK74132Excl. Body Parts/Svcs:Contact: Sheilahips, knees, jointsPhone: (918) 749-0962 Fax: (918) 744-4246

Certification UnknownT R

Neurosurgery Daniel Boedeker, M.D. 6767 S Yale Ave Ste A brain, spine, peripheral nerve for Tulsacarpal tunnelTulsa, OK74136Excl. Body Parts/Svcs:Contact: Laurieall except specialtyPhone: (918) 491-3521 Fax: ( ) -

Certification UnknownT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 29

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Shon W. Cook, M.D. 11317 S Western Ave Ste 300 brain, spine, nerves Oklahoma CityOklahoma City, OK73170

Contact: NicolePhone: (405) 310-6977 Fax: (405) 701-5006

American Board of NeurologicalSurgery

T

Neurosurgery Christopher G. Covington, M.D. Attn: Sheila Harless spine, brain, carpel tunnel Tulsa6802 S Olympia Ave Ste 300Tulsa, OK74132 Excl. Body Parts/Svcs:

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

American Board of NeurologicalSurgery

T

Neurosurgery Allan S. Fielding, M.D. 2000 S Wheeling Ste 1110 head, neck, back, shoulder, hip, Tulsaknee, CTS, ulnar neuropathyTulsa, OK74104Excl. Body Parts/Svcs:Contact: Keeley, MelodyNeurosurgical Cases OnlyPhone: (918) 294-0080 Fax: ( ) -

American Board of NeurologicalSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 30

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Emily D. Friedman, M.D. 3433 NW 56 Ste 750 head, brain, spine, neck, carpal Oklahoma CitytunnelOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Danaall body parts not specifiedPhone: (405) 945-4902 Fax: (405) 945-4901

American Board of NeurologicalSurgery

T

Neurosurgery Eric S. Friedman, M.D. 4120 W Memorial Rd Ste 300 brain and carpal tunnel only Oklahoma CityOklahoma City, OK73120-9322

Excl. Body Parts/Svcs:Contact: Kelsey spine, shoulders, knees, lower

extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T

Neurosurgery Steven E. Gaede, M.D. 6802 S Olympia Ave Ste 300 spine, brain, carpal tunnel, ulnar TulsanerveTulsa, OK74132

[email protected]. Body Parts/Svcs:Contact: Sheila,Susienon-spine orthopedic casesPhone: (918) 749-0762 Fax: (918) 744-4246

American Board of NeurologicalSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 31

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Michael Hahn, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), hands Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Tammy shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T

Neurosurgery Brent N. Hisey, M.D. 14100 Parkway Commons Dr Ste 201 spine (neck, back), brain, carpal Oklahoma CitytunnelOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Alishaall except specialtyPhone: (405) 242-4720 Fax: (405) 242-4933

American Board of NeurologicalSurgery

T

Neurosurgery Donald D. Horton, M.D. 14100 Parkway Commons Dr Ste 201 spinal surgery (cervical/lumbar) Oklahoma Citycarpal tunnelOklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Marie, Alishaall except cervical, lumbar, carpalPhone: (405) 242-4720 Fax: (405) 242-4765tunnel

American Board of NeurologicalSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 32

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Douglas Koontz, M.D. 6767 S Yale Ste A brain, spine (thoracic, cervical, Tulsalumbar), carpal tunnelTulsa, OK74136

noneContact: JaclynPhone: (918) 491-3521 Fax: ( ) -

American Board of NeurologicalSurgery

T R

Neurosurgery Kyle Mangels, M.D. 6802 S Olympia Ave Ste 300 spine, brain, carpal tunnel. ulnar TulsanerveTulsa, OK74132Excl. Body Parts/Svcs:Contact: Sheila, Susiehips, knees, jointsPhone: (918) 749-0762 Fax: (918) 744-4246

American Board of NeurologicalSurgery

T R

Neurosurgery John S. Marouk, D.O. 2128 S Atlanta PL Ste 100 spine, brain only TulsaTulsa, OK74114

Excl. Body Parts/Svcs:Contact: all other body partsPhone: (918) 583-5131 Fax: (918) 592-0670

American Osteopathic Board ofSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 33

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Fadi F Nasr, M.D. 4120 W Memorial Rd, Ste 300 Spine (neck, back), hand Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Stephanie shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: ( ) -

Certification UnknownT

Neurosurgery Stan Pelofsky, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Angie shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-2920

American Board of NeurologicalSurgery

T

Neurosurgery Ryan F. Rahhal, M.D. 6767 S Yale Ave Ste A brain, spine (thoracic, lumbar, & Tulsacervical), carpal tunnelTulsa, OK74136

[email protected]. Body Parts/Svcs:Contact: Laurieall except specialtyPhone: (918) 492-7587 Fax: (918) 492-4033

Certification UnknownT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 34

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Robert L. Remondino, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists (carpal tunnel) Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Linda shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T

Neurosurgery W. Emery Reynolds, M.D. 4120 W Memorial Ste 208 head, spine Oklahoma CityOklahoma City, OK73120

Contact: SondraPhone: (405) 755-3540 Fax: ( ) -

American Board of NeurologicalSurgery

T

Neurosurgery Scott C. Robertson, M.D. 9060 Harmony Dr Ste E neurosurgical cases Midwest CityMidwest City, OK73130

Excl. Body Parts/Svcs:Contact: Cindy shuntsPhone: (405) 737-0203 Fax: (405) 737-0221

American Board of NeurologicalSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 35

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery James A. Rodgers, M.D. 6565 S Yale Ste 709 cervical & lumbar spine carpal Tulsatunnel (Services restricted toTulsa, OK74136opinions regarding the nature andextent of permanent impairment, andContact: Ritaor opinions in claims against thePhone: (918) 481-4965 Fax: (918) 481-4996multi injury trust fund.)

Excl. Body Parts/Svcs:brain, knees, shoulders

American Board of NeurologicalSurgery

R

Neurosurgery Eric W. Sherburn, M.D. 6802 S Olympia Ave Ste 300 brain, spine (neck, back), carpal Tulsatunnel, ulnar nerveTulsa, OK74132

[email protected]. Body Parts/Svcs:Contact: Sheila, Susieorthopedic casesPhone: (918) 749-0762 Fax: (918) 744-4246

American Board of NeurologicalSurgery

T

Neurosurgery Stewart C. Smith, M.D. 3705 NW 63 ST STE 212 head & spine Oklahoma CityOklahoma City, OK73116

Excl. Body Parts/Svcs:Contact: Calie all except within specialtyPhone: (405) 945-4456 Fax: (405) 848-3210

American Board of NeurologicalSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 36

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Brian E. Snell, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), hands Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: CALLIE shoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: ( ) -

American Board of NeurologicalSurgery

T

Neurosurgery Caple A Spence, M.D. 8121 National Ave Ste 210 head, neck, back MWCMidwest City, OK73110

SNSSOKC.com Excl. Body Parts/Svcs:Contact: Joy non-neurosurgicalPhone: (405) 455-3393 Fax: (405) 455-7162

American Board of NeurologicalSurgery

T

Neurosurgery Nathaniel Stetson, D.O. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120

Contact: MarleaPhone: (405) 748-3300 Fax: ( ) -

Certification UnknownT

Neurosurgery Qualls Stevens, D.O. PO Box 30585 all within specialty MWC, OKCMidwest City, OK 7314-0

Excl. Body Parts/Svcs:Contact: Marie, Angie aneurysmsPhone: (405) 455-3322 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 37

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Kevin R. Teal, M.D. 3705 NW 63 Street Ste 212 head & spinal disorders Oklahoma CityOklahoma City, OK73116

Excl. Body Parts/Svcs:Contact: Calie all except specialityPhone: (405) 945-4456 Fax: (405) 848-3210

American Board of NeurologicalSurgery

T R

Neurosurgery Robert E. Tibbs, M.D. 4120 W Memorial Rd Ste 300 TREATMENT AUTHORIZATION for neck,Oklahoma Cityback, wrists (carpal tunnel)Oklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Angieshoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-1671

American Board of NeurologicalSurgery

T

Neurosurgery Frank J. Tomecek, M.D. 6802 S Olympia Ave Ste 300 spine (neck, back), brain, carpal Tulsatunnel, ulner nerveTulsa, OK74132

[email protected] & [email protected]. Body Parts/Svcs:Contact: Sheila, Susielegs, hipsPhone: (918) 749-0762 Fax: (918) 749-8531

American Board of NeurologicalSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 38

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Benjamin T. White, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrist (carpal tunnel) Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Kelsey shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: ( ) -

American Board of NeurologicalSurgery

T

Neurosurgery Robert J. Wienecke, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists{carpal tunnel) Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Marlea shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 748-1671

American Board of NeurologicalSurgery

T

Neurosurgery Gregory L. Wilson, D.O. 9709 E 79 Street South brain, neck, back TulsaTulsa, OK74133

Excl. Body Parts/Svcs:Contact: Pam arms, legs, hands, feetPhone: (918) 994-4068 Fax: (918) 994-4095

Am Board of OsteopathicNeurological Surgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 39

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Obstetrics and Gynecology Joe Paul Merritt, M.D. 5300 N Grand Ste 302 female genetalia Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Heather all except OB/GYNPhone: (405) 943-2376 Fax: (405) 942-1251

American Board of Obstretrics andGynecology

T

Occupational Medicine John W. Ellis, M.D.* 5100 N Brookline Ave Ste 465 head, neck, back, extremities, Oklahoma Citylungs, toxicologyOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: KellyheartPhone: (405) 917-5336 Fax: (405) 917-2250

American Board of Family MedicineT R MITF

Occupational Medicine Val Joseph Fiorazo, M.D. 4330 SE 29 St Ste 3018 back, neck, upper, lower Oklahoma CityextremitiesDel City, OK73115Excl. Body Parts/Svcs:Contact: Dr. Fiorazolungs, heart, brain, skin, hearingPhone: (405) 670-8100 Fax: (405) 670-8558

American Board of Family PracticeT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 40

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine William R. Gillock, M.D. 7170 S Braden Ste 175 all body parts TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Sharon nonePhone: (918) 481-0994 Fax: (918) 494-6747

American Board of Internal Medicine& Preventive Medicine

T R MITF

Occupational Medicine Russell J. Green, M.D. 1044 North Sheridan Road all TulsaTulsa, OK74115

[email protected] Excl. Body Parts/Svcs:Contact: Cherish eyes, ears, nose, throat (ENT) &

psychPhone: (918) 609-1600 Fax: (918) 609-1319

American Board of PreventiveMedicine/Occupational Medicine

T R MITF

Occupational Medicine John W. Hallford, D.O. 5682 W Skelly Dr occupational medicine/urgent care TulsaTulsa, OK74107

[email protected] Excl. Body Parts/Svcs:Contact: Julie nonePhone: (918) 446-1891 Fax: (918) 446-1894

American Osteopathic Board ofFamily Physicians

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 41

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine Kent C. Hensley, M.D.* 9433 N Kelley Ave all Oklahoma CityOklahoma City, OK73131

Excl. Body Parts/Svcs:Contact: Yvonne, Leslie psychiatricPhone: (405) 840-6720 Fax: (405) 840-6723

American Board of Internal Medicine R MITF

Occupational Medicine Andrew C. John, M.D. 4323 NW 63 Street Ste 105 all occupational medicine Oklahoma CityOklahoma City, OK73116

Excl. Body Parts/Svcs:Contact: Jerri NonePhone: (405) 843-0610 Fax: (405) 843-0620

Certification Unknown R MITF

Occupational Medicine William D. Jones, M.D. 707 NW 13 St all occupational medicine (rating Oklahoma Cityonly)Oklahoma City, OK73103Excl. Body Parts/Svcs:Contact: Jeannefemale reproductive systemPhone: (405) 521-8604 Fax: (405) 521-8605

Certification Unknown R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 42

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine John A. Munneke, M.D. 36 W Memorial Ste B9 all including occupational Oklahoma City,medicine, MITF, Form 3, pain TulsaOklahoma City, OK73114management

Contact: JoAnne, KerriExcl. Body Parts/Svcs:Phone: (405) 755-9702 Fax: (405) 755-9718eyes

Certification UnknownT R MITF

Occupational Medicine Robert E. Paul, M.D. 6717 S Yale Ste 107 orthopedics/soft tissue injuries TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Linda NonePhone: (918) 496-1991 Fax: (918) 496-3433

Certification UnknownT R MITF

Occupational Medicine Carl B. Pettigrew, D.O. 1211 N Shartel Ste 500 all Oklahoma City,TulsaOklahoma City, OK73103

Excl. Body Parts/Svcs:Contact: Karen NonePhone: (405) 239-7766 Fax: (405) 235-4895

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 43

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine J. A. Snelling, D.O. PO Box 702738 Occupational Medicine (Services Tulsarestricted to providing opinionsTulsa, OK74170regarding the nature and extent ofpermanent impairment, if any,Contact: selfand/or opinions in combinedPhone: (918) 749-3187 Fax: (918) 491-9925disability claims.)

Excl. Body Parts/Svcs:cardiac

American Board of FamilyPhysicians, Am Board of PreventiveMed.

R MITF

Occupational Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St all TulsaTulsa, OK74107

Excl. Body Parts/Svcs:Contact: Rhonda nonePhone: (918) 742-4881 Fax: (918) 742-5854

Internal MedicineT R MITF

Occupational Medicine Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical OKC, TulsamaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-AmberNonePhone: (918) 488-8285 Fax: (405) 949-1801

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 44

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine LeRoy E. Young, D.O. PO Box 60129 all Oklahoma CityOklahoma City, OK73146-0129

[email protected] Excl. Body Parts/Svcs:Contact: Misty NonePhone: (405) 235-6200 Fax: (405) 235-6206

Occupational MedicineT R MITF

Ophthalmology John P. Belardo, M.D. 11308 N Penn eyes only Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Patti all except eyesPhone: (405) 755-7700 Fax: (405) 755-7739

American Board of OphthalmologyT R MITF

Orthopedic Surgery Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 45

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery John W. Anderson, M.D. 3301 NW 50 St knees, shoulders, ankles Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck, back), handsPhone: (405) 947-0911 Fax: (405) 948-5177

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Kristopher R. Avant, D.O. 8100 S Walker Ave Bldg A upper extremities, hands, wrists, Yukon, OKCelbows, knees, shouldersOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: ( ) -

Certification UnknownT R MITF

Orthopedic Surgery John Charles Balbas, M.D. 4802 S 109 E Ave all except back, neck, hands TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: ( ) -

American Board of OrthopaedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 46

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566

Excl. Body Parts/Svcs:Contact: Pam nonePhone: (918) 994-4068 Fax: (918) 994-4095

Certification UnknownT R

Orthopedic Surgery Jaafar M. Bazih, M.D. 4802 S 109 E Ave extremities, hands TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya spine: back & neckPhone: (918) 392-1400 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

Orthopedic Surgery Jack Beller, M.D. 3301 NW 50 St all orthopedics Oklahoma CityOklahoma City, OK73112

www.okortho.comContact: Central schedulingPhone: (405) 947-0911 Fax: ( ) -

American Board of OrthopaedicSergery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 47

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery James F. Bischoff, M.D.* 6475 S Yale Ave Ste 301 hands, wrists TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda spine, elbows, shoulders, feet,

ankles, knees, hips, rate onlyPhone: (918) 494-5520 Fax: (918) 494-9397cases

American Board of OrthopedicSurgery

T R

Orthopedic Surgery David Bobb, M.D. 825 E Robinson all except back & head NormanNorman, OK73071

Excl. Body Parts/Svcs:Contact: Donna back & headPhone: (405) 364-8855 Fax: ( ) -

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery James Lee Bond, M.D. 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hips, Norman,arms Oklahoma CityNorman, OK73072Excl. Body Parts/Svcs:Contact: BROOKEhands, feet, backPhone: (405) 517-3719 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 48

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda spine, hips, feet, ankles, hands &

rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of OrthopedicSurgery/Sports Medicine

T R

Orthopedic Surgery R. Tyler Boone, M.D. 6475 S Yale Ave Ste 301 neck, back TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda hands, hips, knees, feet, ankles

shoulders, elbows, no rate only casPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of OrthopedicSurgery/AmBd Ortho Surg of theSpine

T R

Orthopedic Surgery Steven P. Brantley, M.D. 3301 NW 50th Street knees and shoulders Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: central scheduling Spine (neck and back)Phone: (405) 947-0911 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 49

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Christopher A. Browne, M.D. 6475 S Yale Ave Ste 301 hips, knees TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda hands, spine, feet, ankles,

shoulders, elbows, no rate onlyPhone: (918) 494-5520 Fax: (918) 494-9397cases

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Mark A. Capehart, M.D. 6475 S Yale Ave Ste 301 neck, back, knees TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda feet, hands, hips, ankles, elbows,

shoulders, no rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of OrthopedicSurgery

T R

Orthopedic Surgery James D. Cash, M.D.* 6585 S Yale Ave Ste 200 knees, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Shann nonePhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 50

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 upper extremities (shoulder down to Tulsafingers)Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Raeknees, back, neck, hips, feetPhone: (918) 925-3226 Fax: (918) 301-4293

American Osteopathic Board ofOrthopedic Surgery

T R

Orthopedic Surgery Kenneth Chekofsky, M.D. 6475 S Yale Ste 202 hands, wrists TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Sharon shoulders, back, neck, hips, knees,

feetPhone: (918) 494-4460 Fax: ( ) -

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Marchel Word Clements, D.O. 2950 S Elm Pl Ste 460 all orthopedic surgery except spine Broken Arrow,TulsaBroken Arrow, OK74012

Excl. Body Parts/Svcs:Contact: Sheree spine (neck, back)Phone: (918) 451-1100 Fax: ( ) -

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 51

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Brian Clowers, M.D. 3400 W Tecumseh Ste 101 foot, ankle OKC, NormanNorman, OK73072

Excl. Body Parts/Svcs:Contact: Brooke all except foot & anklePhone: (405) 517-3719 Fax: (405) 360-6769

Certification UnknownT R

Orthopedic Surgery Ashley Cogar, M.D. 6205 N Santa Fe Ste 200 elbow, wrist, hand Oklahoma CityOklahoma City, OK73118

Excl. Body Parts/Svcs:Contact: Diana, Jennifer spine, shoulder, hip, knee, ankle

or footPhone: (405) 427-6776 Fax: (405) 541-9547

Certification UnknownT

Orthopedic Surgery Arthur Hobart Conley, III, M.D. 3110 SW 89 Ste 200E (spine) back and neck only Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Ashley all except spinePhone: (405) 703-7300 Fax: (405) 703-7333

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 52

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Jimmy Harold Conway, M.D. 10001S Western Ste 101 elbows, knees, shoulders Oklahoma CityOklahoma City, OK73139-2997

Excl. Body Parts/Svcs:Contact: Crystal spine, feet, handsPhone: (405) 692-3749 Fax: (405) 692-3789

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Steven D. Coupens, M.D. 6205 N Santa Fe Ste 200 shoulders, elbows, hands, hips, Oklahoma Cityknees, ankles, feetOklahoma City, OK73118Excl. Body Parts/Svcs:Contact: KatherinebackPhone: (405) 427-6776 Fax: (405) 419-5527

American Board of OrthopedicSurgery

T

Orthopedic Surgery Thomas G. Craven, M.D. 6585 S Yale Ste 200 spine (neck, back) TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Melissa, Linda hands, wrists, elbows, shoulders,

hips, knees, ankles, feetPhone: (918) 481-2767 Fax: (918) 481-7669

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 53

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Stephen R. Davenport, M.D. 3301 NW 50 St knees, hips, feet, ankles, Oklahoma Cityincluding reconstructive surgeryOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Central Schedulingspine, (neck, back), handsPhone: (405) 947-0911 Fax: (405) 948-5177

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Scott De La Garza, M.D. 608 NW 9 Street Ste 6000 spine only (lumbar, cervical, Norman,thorasic) Oklahoma City,Oklahoma City, OK73102

EdmondExcl. Body Parts/Svcs:Contact: Brookeall except spinePhone: (405) 517-3719 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Kevin M. Dukes, M.D. 4802 S 109 E Ave shoulders TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya back, neck, hands, kneesPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 54

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Ronald Matthew Dumigan, M.D. 1110 N Lee Knees, Shoulders, Elbows, ankles, Oklahoma Cityand EdmondOklahoma City, OK73103

Excl. Body Parts/Svcs:Contact: Amy Spine, Neck, HipPhone: (405) 230-9405 Fax: (405) 230-9421

American Board of OrthopedicSurgery

T

Orthopedic Surgery Rory C. Dunham, D.O. PO Box 890358 hand, knee, shoulder, ankle Oklahoma CityOklahoma City, OK73189

Excl. Body Parts/Svcs:Contact: Cindy back, neck feet, head, chestPhone: (405) 759-2663 Fax: ( ) -

American Osteopathic Board ofOrthopedic Surgery

T

Orthopedic Surgery Scott J. Dunitz, M.D. 4802 S 109 E Ave hips, knees (adult reconstruction) TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 55

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Eugene G. Feild, M.D. 6600 S Yale Ste 1315 all within specialty TulsaTulsa, OK74136-3346

Contact: NancyPhone: (918) 481-7770 Fax: (918) 481-7797

American Board of OrthopedicSurgery

T R

Orthopedic Surgery David J. Flesher, M.D. 3301 NW 50 St knees, shoulders only Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck & back), hips, feet,

handsPhone: (405) 947-0911 Fax: (405) 948-5177

American Board of OrthopedicSurgery

T

Orthopedic Surgery Thomas H. Flesher, III, M.D. 3301 NW 50 St shoulders, ankles, knees Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: central scheduling spine (back, neck), wrists, hands,

hips, total knee replacementPhone: (405) 947-0911 Fax: (405) 948-5171

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 56

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Winston Fong, M.D. 1110 N Lee spine only (cervical, thoracic, OKC, Edmondlumbar)Oklahoma City, OK73034Excl. Body Parts/Svcs:Contact: Jenniferall except spinePhone: (405) 230-9490 Fax: ( ) -

American Board of OrthopaedicSurgery

T R

Orthopedic Surgery Dennis E. Foster, M.D. 3130 SW 89 St Ste 100 all Oklahoma CityOklahoma City, OK73159-7900

Excl. Body Parts/Svcs:Contact: NonePhone: (405) 378-4472 Fax: (405) 378-3580

American Board of OrhtopedicSurgery

T R MITF

Orthopedic Surgery Jeff A. Fox, M.D.* 6585 S Yale Ave Ste 200 knees, ankles, elbow, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: appt desk spinePhone: (918) 481-7658 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 57

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Sami R. Framjee, M.D. 2000 S Wheeling Ave Ste 1110 spine and general orthopaedics TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: NonePhone: (918) 294-0080 Fax: (918) 742-2119

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Joel L. Frazier, M.D.* 1044 SW 44 St Ste 600 hands, upper extremities, elbows, Oklahoma CitywristsOklahoma City, OK73109Excl. Body Parts/Svcs:Contact: Stephanieall except hands, elbows, wristsPhone: (405) 631-4263 Fax: ( ) -

American Board of OrthopedicSurgery

T

Orthopedic Surgery Charles H. Funderburk, M.D.* 1110 N Lee hands, shoulders, elbows, knees, Edmond,wrists, forearm Oklahoma CtiyOklahoma City, OK73103-2612

[email protected]. Body Parts/Svcs:Contact: neck, back, hips, feetPhone: (405) 230-9743 Fax: (405) 522-9474

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 58

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Timothy Michael Geib, M.D. 13800 Benson Rd Ste 210 knees, shoulders, elbows, hips, Edmond, OKChands, armsEdmond, OK73013Excl. Body Parts/Svcs:Contact: Brookefeet, backPhone: (405) 517-3719 Fax: ( ) -

Certification UnknownT R MITF

Orthopedic Surgery Robert A. German, M.D. 1110 N Lee knees, shoulders, elbows, ankles, Oklahoma City,arms, legs NormanOklahoma City, OK73103-2612Excl. Body Parts/Svcs:Contact: Jenniferback, neckPhone: (405) 230-9400 Fax: (405) 230-9600

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Greg Halko, M.D.* 3301 NW 50 hands, upper extremities Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) and lower

extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 59

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Kevin Wayne Hargrove, M.D. 10914 Hefner Pointe Dr Ste 200 shoulders, knees, elbows Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Julie neck, back, feet, hands-major

traumaPhone: (405) 749-8326 Fax: (405) 749-8328

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Bryan Hawkins, M.D.* 6585 S Yale Ave Ste 200 ankles, knees, feet, hip TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Beth neck, spine, wrists, hands, elbowsPhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Don L. Hawkins, M.D. 6585 S Yale Ave Ste 200 neck and spine TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Shann, Brian knees, hips, hands, shoulders,

anklesPhone: (918) 481-7654 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 60

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Randall L. Hendricks, M.D. 6585 S Yale Ste 200 neck, spine TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Allison shoulders, elbows, hips, knees

hands, wristsPhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery David R. Hicks, M.D. 6585 S Yale Ave Ste 200 neck and spine TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Denise, Linda hands, wrists, elbows, shoulders,

knees, hipsPhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Robert Frazer Hines, M.D. 1616 S Kelly shoulders, knees EdmondEdmond, OK73013

Excl. Body Parts/Svcs:Contact: Melissa hips, hands, backsPhone: (405) 348-6004 Fax: (405) 715-8853

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 61

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Gregory R. Holt, M.D. 1809 E 13 St Ste 100 hips, knee, shoulders TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Tracy spine, handsPhone: (918) 925-3293 Fax: (918) 582-6060

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Thomas C. Howard, M.D.* 1110 N Lee hands, shoulders, knees, hips and Oklahoma City,feet NormanOklahoma City, OK73103-2612

[email protected]. Body Parts/Svcs:Contact: schedulingspine, (neck,back)Phone: (405) 230-9752 Fax: (405) 230-9424

American Board of OrthopedicSurgery

T R

Orthopedic Surgery John B. Hughes, D.O. 2149 SW 59 St Ste 102 all Oklahoma CityOklahoma City, OK73119

Excl. Body Parts/Svcs:Contact: Tammy nonePhone: (405) 682-5351 Fax: (405) 685-5563

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 62

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Christopher Shane Hume, D.O. 8100 S Walker Ave Bldg A spine (neck & back), carpal tunnel Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Julie all except specialityPhone: (405) 632-4468 Fax: (405) 632-4317

Board EligibleT R MITF

Orthopedic Surgery Antoine I. Jabbour, M.D. 4802 S 109 E Ave knees, shoulders TulsaTulsa, OK74146

None Excl. Body Parts/Svcs:Contact: Latoya spine, handsPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

Orthopedic Surgery Thomas P. Janssen, M.D. 1110 N Lee knees, hips, shoulders, feet, hands Oklahoma CityOklahoma City, OK73103-2612

[email protected] Excl. Body Parts/Svcs:Contact: Cynthia neck,backPhone: (405) 230-9743 Fax: (405) 230-9474

American Board of Family Medicine &Orthopaedic Surgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 63

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery J. Calvin Johnson, M.D. 6205 N Santa Fe Ste 200 knees, shoulders Oklahoma CityOklahoma City, OK73118

Excl. Body Parts/Svcs:Contact: Jennifer back,hands,anklesPhone: (405) 419-5412 Fax: (405) 419-5468

American Board of OrthopedicSurgery

T

Orthopedic Surgery Wayne A. Johnson, M.D. PO Box 7137 shoulder, knee, hand/wrist, Lawtonfoot/ankleLawton, OK73506

[email protected]. Body Parts/Svcs:Contact: Cassandraback, neckPhone: (580) 695-9919 Fax: (580) 536-7805

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Daniel J. Jones, M.D. 8100 S Walker Ave Bldg A knee, shoulder, foot, ankle, legs, Oklahoma Cityarms, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: JuliespinePhone: (405) 632-4468 Fax: (405) 632-4317

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 64

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery John F. Josephson, M.D. 4802 S 109 E Ave all except back, neck, hands TulsaTulsa, OK74146

None Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1404

American Board of OrthopedicSurgery

T

Orthopedic Surgery Michael E. Kiehn, M.D. 3301 NW 50 St knees, shoulders Oklahoma CityOklahoma City, OK73112

www.okortho.com Excl. Body Parts/Svcs:Contact: Central Scheduling spine (neck, back)Phone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Norman,hips, ankles, arms Oklahoma CityNorman, OK73072Excl. Body Parts/Svcs:Contact: BrookefeetPhone: (405) 517-3719 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 65

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Zakary A. Knutson, M.D. 3400 W Tecumseh Ste 101 hips, knees, shoulders Norman, EdmondNorman, OK73072

[email protected] Excl. Body Parts/Svcs:Contact: Brooke all except hips, knees, shouldersPhone: (405) 517-3719 Fax: ( ) -

Certification UnknownT R

Orthopedic Surgery Mark F. Kowalski, M.D. 4140 W Memorial Rd Ste 308 all orthopaedic surgery except Oklahoma Cityspine, hipsOklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Kayla, Shawna, Cathyhips, spinePhone: (405) 749-7031 Fax: (405) 749-7036

American Board of OrthopedicSurgery

T R

Orthopedic Surgery E. Alexander L'Heureux, Jr., M.D. 1405 NW 150 St cervical, thoracic and lumbar spine EdmondEdmond, OK73013

Excl. Body Parts/Svcs:Contact: Jennifer all except spinePhone: (405) 844-5222 Fax: (405) 744-2166

American Board of OrthopedicSurgery & Spine Surgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 66

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Ronald S. LaButti, D.O.* 6585 S Yale Ave Ste 200 hips, knees, ankles, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: appt desk backPhone: (918) 481-7658 Fax: (918) 481-7611

American Osteopathic Aacademy ofOrthopedics

T R MITF

Orthopedic Surgery Bradley J. Lawson, M.D. 6585 S Yale Ave Ste 200 ankle, shoulder, hip, knee, foot, Tulsa, OwassoelbowTulsa, OK74136Excl. Body Parts/Svcs:Contact: Shann, Amberneck, spine, handPhone: (918) 481-2767 Fax: ( ) -

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Brian A. Levings, D.O. 8100 S Walker Ave Bldg A arms, legs, shoulders, knees, feet, Oklahoma Cityankles, elbowsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317

American Osteopathic Board ofOrthopaedic Surgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 67

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Alan G. Lewis, M.D. 6475 S Yale Ave Ste 301 feet, ankles, knees TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: CJ/Linda spine, hips, hands, elbows,

shoulders, rate only casesPhone: (918) 494-9351 Fax: (918) 494-9397

American Board of OrthopedicSurgery

T R

Orthopedic Surgery J. Patrick Livingston, M.D. 4205 McAuley Blvd Ste 301 general orthopedic evaluations, Oklahoma Citytreatment for non-surgicalOklahoma City, OK73120orthopedic cases

Contact: KendallExcl. Body Parts/Svcs:Phone: (405) 463-0407 Fax: (405) 463-0425jaws, ribs, internal medicine,psychological overlay

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Jay D. Lorton, M.D. 6475 S Yale Ave Ste 301 knees, shoulders, ankles, elbows TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Linda spine, hands, hips, feetPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 68

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Paul D. Maitino, D.O. 3110 SW 89 Street Ste 200D hips, knees, shoulders, hands , Oklahoma Citywrist, ankle, back, neckOklahoma City, OK73159Excl. Body Parts/Svcs:Contact: KimberlyheadPhone: (405) 680-5633 Fax: (405) 735-6435

Orthopedic SurgeryT R MITF

Orthopedic Surgery Thomas A. Marberry, M.D. 4802 S 109 E Ave shoulders TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Bradley Margo, M.D. 1110 N Lee shoulders, knees Oklahoma CityOklahoma City, OK73103-2612

Excl. Body Parts/Svcs:Contact: Central Scheduling backs, necks, hips, feetPhone: (405) 230-9000 Fax: ( ) -

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 69

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Corey E. Mayo, D.O. 13900 Quailbrook Drive knee, shoulder, arm, leg Oklahoma CityOklahoma City, OK73134-1718

[email protected] Excl. Body Parts/Svcs:Contact: Tanya spinePhone: (405) 418-4500 Fax: ( ) -

Certification UnknownT R

Orthopedic Surgery James C. Mayoza, M.D. 6122 E 61 St spine & extremities TulsaTulsa, OK74136-2117

Excl. Body Parts/Svcs:Contact: Brenda handPhone: (918) 492-3133 Fax: (918) 493-2215

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery James D. Mitchell, M.D. 1110 N Lee hips, knees OKC, NormanOklahoma City, OK73103

Excl. Body Parts/Svcs:Contact: Pam shoulders, wrists, elbows, hands,

feet, spinePhone: (405) 230-9488 Fax: ( ) -

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 70

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Yogesh Mittal, M.D. 1809 E 13 St Ste 100 hips, knees TulsaTulsa, OK74104

[email protected]: RaePhone: (918) 925-3226 Fax: (918) 301-4293

American Board of OrthopaedicSurgery

T R

Orthopedic Surgery Mac E. Moore, M.D. 10001 S Western Ste 101 shoulders, elbows, knees Oklahoma CityOklahoma City, OK73139-2997

Excl. Body Parts/Svcs:Contact: Shellie spine, feetPhone: (405) 692-3737 Fax: (405) 692-3707

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Jeffrey R. Morris, D.O.* 802 S Jackson Ste 405 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74127

[email protected]. Body Parts/Svcs:Contact: Reggieneck, spinePhone: (918) 583-4400 Fax: (918) 583-7908

American Osteopathic Board ofOrthopedfic Surgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 71

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Mark Robert Moses, M.D. 825 E Robinson hips, knees, shoulders,hands, NormanwristsNorman, OK73071Excl. Body Parts/Svcs:Contact: Ginaneck, backPhone: (405) 364-7900 Fax: (405) 366-6214

American Board of OrthopaedicSurgery

T R

Orthopedic Surgery Gene L. Muse, M.D. 4200 W Memorial Rd Ste 1001 all except spine Oklahoma CityOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Penny (spine) back, neckPhone: (405) 787-7678 Fax: (405) 751-3367

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Robert W. Nebergall, D.O. 9709 E 79 St South arms, legs, shoulders, hands, Tulsaknees, feet, fingers, toesTulsa, OK74133Excl. Body Parts/Svcs:Contact: Pamback, neck, brainPhone: (918) 994-4068 Fax: (918) 994-4095

American Osteopathic Board ofOrthopedic Surgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 72

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Ryan L. Nelson, D.O 10001 S Western Ste 101 shoulder, elbow, knee Oklahoma City(trauma/fractures) hip, wrist,Oklahoma City, OK73139ankle

Contact: ToyeExcl. Body Parts/Svcs:Phone: (405) 692-3700 Fax: ( ) -none

Certification UnknownT R MITF

Orthopedic Surgery David E. Nonweiler, M.D. 6585 S Yale Ave Ste 200 shoulders, knees TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Melissa neck and spinePhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery M. Sean O'Brien, D.O.* PO Box 890358 hands only Oklahoma CityOklahoma City, OK73189

Excl. Body Parts/Svcs:Contact: Cindy Burditt back, neck, feetPhone: (405) 759-2663 Fax: ( ) -

American Osteopathic Board ofOrthopedic Surgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 73

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery James M. Odor, M.D. 14100 Parkway Commons Dr Ste 200 cervical, thorasic & lumbar spine Oklahoma City(neck and back)Oklahoma City, OK73134Excl. Body Parts/Svcs:Contact: Valerie, ReneeNonePhone: (405) 242-4345 Fax: (405) 242-4333

American Board of OrthopedicSurgery

T

Orthopedic Surgery L. Todd Olsen, D.O. Olsen Orthopedics knees, shoulders MWC3400 S Douglas Blvd Ste 305

[email protected] Oklahoma City, OK73150 Excl. Body Parts/Svcs:Contact: Andrea, Wendy, Cheryl backsPhone: (405) 733-8000 Fax: (405) 733-7820

American Osteopathic Board ofOrthopedic Surgery

T

Orthopedic Surgery Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 knees, shoulders TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Rae feet, fingers, back pelvis, neckPhone: (918) 925-3226 Fax: ( ) -

American Osteopathic BoardT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 74

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Kris Parchuri, D.O. 9101 S Toledo Ave Ste B spine TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Danielle hands, feetPhone: (539) 664-4448 Fax: (539) 664-4288

Certification UnknownT R MITF

Orthopedic Surgery Andrew Parkinson, M.D. 3301 NW 50 St spine, (neck, back), lower Oklahoma CityextremitiesOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: central schedulingall except spine & lowerPhone: (405) 947-0911 Fax: ( ) -extremities

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Corey Eugene Ponder, M.D. 13800 Benson Rd Ste 201 joint replacement and revision Edmond, OKC(knees and hips only)Edmond, OK73013Excl. Body Parts/Svcs:Contact: Brookeall except knees, hipsPhone: (405) 517-3719 Fax: ( ) -

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 75

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand Oklahoma CityOklahoma City, OK73112-4418

Excl. Body Parts/Svcs:Contact: back and lower extremitiesPhone: (405) 945-4888 Fax: (405) 945-4887

American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand

T R

Orthopedic Surgery Vytautas M. Ringus, M.D. 825 E Robinson foot and ankle NormanNorman, OK73071

Excl. Body Parts/Svcs:Contact: Donna hands, shouldersPhone: (405) 364-8855 Fax: (405) 310-6866

Certification UnknownT R

Orthopedic Surgery R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 neck, spine, elbows, wrists, hips, Tulsaknees, anklesTulsa, OK74136

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

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 76

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Fred M. Ruefer, M.D. 209 S 36 St bones & joints MuskogeeMuskogee, OK74401

Excl. Body Parts/Svcs:Contact: Katrina back, neckPhone: (918) 682-7717 Fax: (918) 682-9434

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Richard A. Ruffin, M.D.* 3301 NW 50 hands, wrists, elbows, shoulders Oklahoma CityOklahoma City, OK73112-5691

Excl. Body Parts/Svcs:Contact: Central Scheduling neck, back, feet, kneesPhone: (405) 947-0911 Fax: (405) 947-4263

American Board of OrthopedicSurgery, Hand Surgery

T

Orthopedic Surgery David Saxton, M.D. 1110 N Lee knees, shoulders, elbows OKC, Norman,EdmondOklahoma City, OK73103

Excl. Body Parts/Svcs:Contact: Vickie hands, spinePhone: (405) 230-9437 Fax: ( ) -

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 77

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Steven Schultz, M.D. 825 E Robinson hips, knees (total hip replacement Norman& total knee replacement)Norman, OK73071Excl. Body Parts/Svcs:Contact: Donnaback, neckPhone: (405) 364-8855 Fax: ( ) -

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Houshang Seradge, M.D.* 1044 SW 44 Street Ste 600 hands, wrists Oklahoma CityOklahoma City, OK73109-8121

Excl. Body Parts/Svcs:Contact: Denise all except hands & wristsPhone: (405) 631-4263 Fax: (405) 631-1767

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery James C. Slater, M.D. 4802 S 109 E Ave adult reconstruction TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya hands, feet, spinePhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 78

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Glenn L. Smith, D.O. 2149 SW 59 Ste 101 all orthopedic surgery Oklahoma CityOklahoma City, OK73119

Excl. Body Parts/Svcs:Contact: Linda NonePhone: (405) 682-4651 Fax: (405) 682-3391

Orthopedic SurgeryT R

Orthopedic Surgery Sheryl C. Smith, M.D. 6205 N Santa Fe Ste 200 foot, ankle Oklahoma CityOklahoma City, OK73118

Excl. Body Parts/Svcs:Contact: Kim all except foot & anklePhone: (405) 419-5610 Fax: (405) 419-5429

Certification UnknownT R

Orthopedic Surgery Cheng-Lun Soo, M.D. 1044 SW 44 Street spine only Oklahoma CityOklahoma City, OK73109

Excl. Body Parts/Svcs:Contact: Stephanie all except neck and backPhone: (405) 631-4263 Fax: (405) 631-1767

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 79

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Richard M. Stamile, M.D. 4802 S 109 E Ave general orthopedic surgery TulsaTulsa, OK74146

[email protected] Excl. Body Parts/Svcs:Contact: Latoya back, neck, handsPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Wesley Michael Stotler, D.O. 4802 S 109 E Ave foot, ankle TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya all except feet and anklesPhone: (918) 392-1473 Fax: (918) 392-1401

American Osteopathic Board ofOrthopedic Surgery

T

Orthopedic Surgery Richard D. Thomas, M.D. 4802 S 109 E Ave Ste300 spine (neck, back) TulsaTulsa, OK74146

Excl. Body Parts/Svcs:Contact: Latoya all except back & neckPhone: (918) 392-1437 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 80

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Robert S. Unsell, M.D. 10001 S Western Ste 101 hands, upper extremities Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Darcy spine, lower extremitiesPhone: (405) 692-3748 Fax: (405) 923-3783

Certification UnknownT R MITF

Orthopedic Surgery Derek L. West, D.O.* 8100 S Walker Ste A shoulders, knees, arms, legs, feet, Oklahoma Cityankles, hips, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317

American Osteopathic Board ofOrthopedic Surgery

T R MITF

Orthopedic Surgery Mark Stephen Wilson, M.D.* 5522 S Lewis all orthopedics, continuing medical Tulsa, OKCmaintenanceTulsa, OK74105Excl. Body Parts/Svcs:Contact: TU-Sandra, OKC-AmberNonePhone: (918) 488-8285 Fax: (405) 949-1801

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 81

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery David K. Wong, M.D. 6585 S Yale Ave Ste 200 hands, wrists, elbows, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Patti neck, spine, knees, hips, anklesPhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Michael Wright, M.D. 3115 SW 89 spine Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Krista NonePhone: (405) 424-5630 Fax: (405) 692-1632

American Board of Spine SurgeryT

Orthopedic Surgery Gregory J. Zeiders, D.O. 1600 Medical Center Drive trauma & sports medicine Edmond,Oklahoma City,Edmond, OK73034ShawneeExcl. Body Parts/Svcs:

Contact: Lindsay, Sue spinePhone: (405) 359-2266 Fax: (405) 359-0215

American Osteopathic Board ofOrthopedic Surgery

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 82

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 shoulder, knee, foot, ankle TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Rae nonePhone: (918) 925-3226 Fax: (918) 582-6060

American Board of OrthopaedicSurgery

T R MITF

Orthopedics Stephen B. Conner, M.D. 1616 S Kelly all orthopedics/sports medicine okcexcept spineEdmond, OK73013Excl. Body Parts/Svcs:Contact: KarispinePhone: (405) 348-3201 Fax: (405) 348-3204

American Board of OrthopedicSurgery

T R

Orthopedics Joel M. Davis, M.D. 3301 NW 50 Street lower extremities, feet, ankles OKCOklahoma City, OK73112

www.okortho.com Excl. Body Parts/Svcs:Contact: central scheduling neck, backPhone: (405) 947-0911 Fax: (405) 947-1341

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 83

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics William Bentley Edmonds, M.D. 1110 N Lee foot, ankle Oklahoma City,Edmond, NormanOklahoma City, OK73103-2612

Excl. Body Parts/Svcs:Contact: Chiquita, Cindy all except foot and anklePhone: (405) 230-9745 Fax: (405) 230-9424

American Board of OrthopaedicSurgery

T R

Orthopedics David Holden, M.D. 1110 N Lee knees & shoulders only Oklahoma CityOklahoma City, OK73103-2612

Excl. Body Parts/Svcs:Contact: Lynn back & neckPhone: (405) 230-9406 Fax: ( ) -

American Board of OrthopaedicSurgery & Sports Medicine

T

Orthopedics Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hips, ankles, arms NormanNorman, OK73072Excl. Body Parts/Svcs:Contact: BrookefeetPhone: (405) 517-3719 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 84

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Otolaryngology R. Stanley Baker, M.D. 3400 NW 56 St ears Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Dawn all other than earsPhone: (405) 946-5563 Fax: ( ) -

American Board of OtolaryngologyT R

Otolaryngology Alen Munson Fuller, M.D. 1725 E 19 St Ste 100 ears (cumulative hearing loss) TulsaTulsa, OK74104

Excl. Body Parts/Svcs:Contact: Betsi, Loetta surgical casesPhone: (918) 742-7376 Fax: (918) 743-2117

American Board of OtolaryngologyT R

Otolaryngology John R. Houck, M.D. 920 Stanton L Young WP 1290 ear, nose, throat OKCOklahoma City, OK73104

Excl. Body Parts/Svcs:Contact: Tiffney complaints of dizzinessPhone: (405) 271-5504 Fax: (405) 271-3248

American Board of Otolaryngology R

Otology Mark Wood, M.D. 3400 NW 56 St ears, hearing, including dizziness Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Valoree throat, sinus, anything other than

earsPhone: (405) 946-5563 Fax: (405) 945-7185

American Board of OtolaryngologyT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 85

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Donald E. Adams, M.D. 1616 S Kelly pain management Oklahoma City,Rehabilitation EdmondEdmond, OK73013-3651

Excl. Body Parts/Svcs:Contact: Joann feet, anklesPhone: (405) 330-0015 Fax: (405) 330-0092

American Board of Medicine &Rehabilitation & Pain Medicine

T R MITF

Physical Medicine and Archana Barve, M.D. 5701 N Portland Ave Ste 210 sports medicine, physical medicine Oklahoma City,Rehabilitation & rehabilitation EdmondOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Sergio, Laurenspinal cord injury with paraplegia,Phone: (405) 949-6481 Fax: (405) 604-6434quadriplegia

American Board of PhysicalMedicine/Rehabilitation

T

Physical Medicine and Albert J. Bisson, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, spine, upper and Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120

problemsContact: Cecylia

Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic mngmt, rsd

American Board of PhysicalMedicine/Rehabilitation

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 86

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Christopher Bouvette, M.D. 4120 W Memorial Rd Ste 118 physicatry, neck, spine, upper & Oklahoma CityRehabilitation lower extremities, nerve and jointOklahoma City, OK73120

problemsContact: Ceyclia

Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management, RSD

American Board of PhysicalMedicine/Rehabilitation +

T R

Physical Medicine and Kimberly Bouvette, M.D. 4120 W Memorial Rd Ste 118 physiatry, neck, spine, upper & Oklahoma CityRehabilitation lower extremities, nerve & jointsOklahoma City, OK73120

Excl. Body Parts/Svcs:Contact: Cecylianarcotic pain management, RSDPhone: (405) 748-4700 Fax: (405) 748-5638

American Board of PhyscialMedicine/Rehabilitation

T R

Physical Medicine and Michael S. Brown, M.D. 4120 W Memorial Rd Ste 118 physiatry - head, neck, spine Oklahoma CityRehabilitation upper and lower extremities, nerveOklahoma City, OK73120

and joint problemsContact: Cecylia

Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management, RSD

American Academy of PhysicalMedicine/Rehab

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 87

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Michael J. Carl, M.D. 105 S Bryant Ave Ste 301 comprehensive pain management, all EdmondRehabilitation chronic pain conditionsEdmond, OK73034

Excl. Body Parts/Svcs:Contact: Dixieabdominal, pudendal, testicularPhone: ( ) - Fax: ( ) -

American Board of Physical Medicineand Rehabilitation

T R MITF

Physical Medicine and J. Jason Jackson, M.D. 3330 NW 56 Street all within specialty Oklahoma CityRehabilitation Suite 612

Oklahoma City, OK73112 Excl. Body Parts/Svcs:Contact: Central Scheduling nonePhone: (405) 601-8810 Fax: (877) 795-8060

American Board of PhysicialMedicine/Rehabilitation

T R MITF

Physical Medicine and A. E. Moorad, M.D.* 4221 S Western Ste 3010 all PM & R, pain managment Oklahoma CityRehabilitation Oklahoma City, OK73109

Contact: MarilynPhone: (405) 636-7450 Fax: (405) 631-2296

American Board of Internal MedicineT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 88

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, ShawneeRehabilitation physical medicine andOklahoma City, OK73102

[email protected]: Kendra, Brittany

Excl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial

American Board of Family Medicine &Sports Medicin

T

Physical Medicine and Darryl Dermot Robinson, M.D. 3110 SW 89 Ste 102 all within speciality Oklahoma CityRehabilitation Oklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Lindsey NonePhone: (405) 703-4950 Fax: (405) 703-4955

American Board of Physical Medicineand Rehab-Pain Management

T R

Physical Medicine and Charles Shields, M.D. 330 S 5 St Ste 305 all physical medicine and EnidRehabilitation rehabilitation, all neuro-musculo-Enid, OK73701

skeletalContact: Amber

Excl. Body Parts/Svcs:Phone: (580) 242-1224 Fax: ( ) -anything except listed services

American Board of PhysicalMedicine/Rehabilitation

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 89

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Kathleen M. Sisler, M.D. 6585 S Yale Ave Ste 200 elbows, hands, knees, hips, neck, TulsaRehabilitation spine, feet, ankles, wrists,Tulsa, OK74136

shoulders (Physiatry)[email protected]: Allison

Excl. Body Parts/Svcs:Phone: (918) 481-2767 Fax: (918) 481-7669none

American Board of PhysicalMedicine/Rehabilitation

T R MITF

Physical Medicine and Michael Shawn Smith, M.D. 5100 N Brookline Ste 500 PM&R, spine, spinal cord and brain Oklahoma CityRehabilitation injuriesOklahoma City, OK73112

Contact: AleciaPhone: (405) 605-8780 Fax: (405) 605-8782

American Board of PhysicalMedicine/Rehabilitation

T R MITF

Physical Medicine and Jonathan B. Stone, D.O. 700 NW 7 Street Ste 115 all within speciality Oklahoma CityRehabilitation Oklahoma City, OK73102

Excl. Body Parts/Svcs:Contact: chronic medication management,

continuing medical maintenancePhone: (405) 601-5899 Fax: (405) 601-5903

American Board of Physical Medicineand Rehabilitation

T

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 90

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and D. Brent Tipton, M.D. 5100 N Brookline Ste 530 all within speciality, Oklahoma CityRehabilitation electrodiagnostic testingOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Lindaheart, lungs, GI, Renal, medicalPhone: (405) 604-6652 Fax: (405) 604-6653maintenance, fibromyalgia, headache

American Board of PhysicalMedicine/Rehabilitation/Electrodiagnos

T R

Plastic Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists

American Board of Plastic Surgery &Am Bd Plastic Surg of Hand

T R MITF

Plastic Surgery Garland Porterfield, M.D. 3727 NW 63 Ste 200 plastic surgery of hands, upper & Oklahoma Citylower extremities, face, head &Oklahoma City, OK73116neck

Contact: SusieExcl. Body Parts/Svcs:Phone: (405) 848-9700 Fax: (405) 848-7297None

American Board of Plastic Surgery,American Board of Surgery

R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 91

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Podiatry Armando A. Carro, D.P.M. 600 W 15 St foot, ankle EdmondEdmond, OK73013

[email protected] Excl. Body Parts/Svcs:Contact: Ann NonePhone: (405) 348-4141 Fax: (405) 340-0686

Certification UnknownT

Podiatry David C. Cavallaro, D.P.M. 7370 S Walker Ave feet, ankles and related structures Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: Debra legPhone: (405) 631-2333 Fax: ( ) -

American Board of Podiatric SurgeryT

Podiatry Kenneth R. Golda, D.P.M. 1522 SW 89 St feet, ankles only Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Linda all except foot & anklePhone: (405) 691-6694 Fax: ( ) -

American Board of PodiatricOrthopedics

T R MITF

Podiatry Christopher J. Green, D.P.M. 13900 Quailbrook Drive feet/ankles (Podiatry/Surgery) Kingfisher,EdmondOklahoma City, OK73134-1718

Excl. Body Parts/Svcs:Contact: Rhonda all except specialtyPhone: (405) 463-4140 Fax: (405) 463-4143

Certification UnknownT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 92

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Podiatry William Dale Hall, D.P.M. 1104-8 S Air Depot Blvd feet, ankles Midwest CityMidwest City, OK73110

Contact: NitaPhone: (405) 733-2783 Fax: ( ) -

American Board of MultipleSpecialties in Podiatry

T

Podiatry Timothy Siegfried, D.P.M. 10229 E 96 Street North Ste 100 foot, ankle Owasso, SapulpaOwasso, OK74055

Excl. Body Parts/Svcs:Contact: Terri none within specialtyPhone: (918) 494-2902 Fax: ( ) -

American Board of Podiatric SurgeryT R MITF

Podiatry G. Trent Smith, D.P.M. 3330 NW 56 Street Ste 600 feet, ankles (Podiatry/Surgery) OKCOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Rhonda all except specialtyPhone: (405) 947-8041 Fax: ( ) -

Certification UnknownT R

Podiatry William K. Smith, D.P.M. 1627 N Kickapoo toes, feet, ankles Shawnee,Oklahoma CityShawnee, OK74804

Contact: Susan, ShawPhone: (405) 275-8234 Fax: (405) 275-7298

American Board of Podiatric SurgeryT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 93

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Podiatry Richard J Traczyk, II, D.P.M. 4205 McAuley Blvd Ste 465 foot, ankle Oklahoma CityOklahoma City, OK73120

[email protected]: LanaePhone: (405) 755-7600 Fax: (405) 755-7680

Certification UnknownT R MITF

Podiatry Trenton Wallace, D.P.M. 1044 SW 44th St Ste 600 anything below the knee Oklahoma CityOklahoma City, OK40563-2168

Excl. Body Parts/Svcs:Contact: Tami anthing above the kneePhone: (405) 632-1680 Fax: ( ) -

Certification UnknownT

Psychiatry Michelle M. Holloway, M.D. 2000 E 15 Street Ste 400A all within speciality EdmondEdmond, OK40534-1169

Excl. Body Parts/Svcs:Contact: Stephen nonePhone: (405) 341-1697 Fax: ( ) -

Certification UnknownT R MITF

Psychiatry Sarah E. Land, D.O. 3314 E 46 Street Ste 200 Psychiatry TulsaTulsa, OK74135

Excl. Body Parts/Svcs:Contact: Emily nonePhone: (918) 591-2510 Fax: ( ) -

American Board of Psychiatry &Neurology

MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 94

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychiatry Dominic Losacco, M.D. 6565 S Yale Ave Ste 706 all within psychiatric specialty TulsaTulsa, OK74136-8308

Contact: Mary, MitziePhone: (918) 491-5767 Fax: (918) 491-5771

American Board of Psychiatry andNeurology

Psychiatry Siavash Nael, M.D. 4720 S Western Ave psychiatry Oklahoma CityOklahoma City, OK73109-3834

Contact: MistyPhone: (405) 634-5529 Fax: (405) 634-1673

American Board of Pyschiatry andNeurology

T

Psychiatry Ola Nawar, M.D. 1145 SW 74 Street Bldg I Ste 200 all within specialty, pain OKCmanagementOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: ShantelnonePhone: (405) 942-0411 Fax: (405) 942-0450

American Board of Psychiatry andNeurology

T

Psychiatry Peter A. Rao, M.D. 5544 S Lewis Ave Ste 600 Psychiatry, neuropsychiatry, Tulsaaddiction medicineTulsa, OK74105Excl. Body Parts/Svcs:Contact: Taylor, DannonePhone: (918) 747-4900 Fax: (918) 747-4903

American Board of PsychiatryandNeurology

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 95

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychology - Clinical Russell L. Adams, Ph.D.* PO Box 26901 WP3440 brain, pain management, Oklahoma Citypsychological overlayOklahoma City, OK73126

Contact: DemareePhone: (405) 271-8001 Fax: (405) 271-8802

American Board of ProfessionalPsychology/Clinical Neuropsych

R MITF

Psychology - Clinical Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehabilitation (nervous system, Tulsawhole body) Trauma RelatedTulsa, OK74136Disorders (pain stress, depression,brain)Contact: Suzan

Phone: (918) 746-0794 Fax: ( ) -Excl. Body Parts/Svcs:none

Certification UnknownT R MITF

Psychology - Clinical Grady L. Blackwood, Ph.D. 3037 NW 63 Street Ste 255 clinical psycholology Oklahoma CityOklahoma City, OK73116

Excl. Body Parts/Svcs:Contact: self suicidal-homocidal casesPhone: (405) 843-8026 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 96

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychology - Clinical Douglas O. Brady, Ph.D.* 1401 SW Park Ridge Blvd Ste D medical psychology, neuropsychology LawtonevaluationsLawton, OK73505

[email protected]: D'AnnPhone: (580) 355-7474 Fax: (580) 355-6765

American Board of ProfessionalDisability

T R MITF

Psychology - Clinical R. Keith Green, Ph.D. 5929 N May Ave Ste 508 psychological evaluations and Oklahoma CitytherapyOklahoma City, OK73112

[email protected]. Body Parts/Svcs:Contact: VirginiaNonePhone: (405) 842-6446 Fax: (405) 842-5644

Certification UnknownT

Psychology - Clinical David E. Johnsen, Ph.D. 2601 NW Expway Ste 410 W psychological overlay Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Lea NonePhone: (405) 755-8576 Fax: (405) 755-6026

Certification UnknownT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 97

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychology - Clinical Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082Excl. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021

Certification UnknownT R MITF

Psychology - Clinical James G. Scott, Ph.D.* PO Box 26901 brain/emotions Oklahoma CityOklahoma City, OK73126-0901

Excl. Body Parts/Svcs:Contact: Barbara NonePhone: (405) 271-5253 Fax: (405) 271-5759

American Board of ProfessionalPsychology

T R MITF

Psychology - Clinical Doris Wise, Ph.D. 3441 W Memorial Ste 7 psychological: mood, coping, Oklahoma Cityadjustment, rehabOklahoma City, OK73134

[email protected]. Body Parts/Svcs:Contact: DebbienonePhone: (405) 286-6000 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 98

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychology Michael R. Basso, Ph.D.* Univ of Tulsa Dept of Psychology head/brain - diatnostic testing, Tulsapsychological overlay800 S Tucker Drive

[email protected] Tulsa, OK74104Excl. Body Parts/Svcs:Contact: Dr. BassoNonePhone: (918) 631-3151 Fax: (918) 631-2833

ABPP - Clinical Neuropsychology R MITF

Psychology Stephen D. Carella, Ph.D. 3035 NW 63 Ste 103 psychological overlay Oklahoma CityOklahoma City, OK73116

Excl. Body Parts/Svcs:Contact: Sue all except specialtyPhone: (405) 840-4212 Fax: (405) 840-4258

Certification UnknownT R

Psychology Jeri Fritz, Ph.D. 624 S Boston Ste 311 psychological overlay TulsaTulsa, OK74119

[email protected] Excl. Body Parts/Svcs:Contact: Dr. Jeri Fritz PhysicalPhone: (918) 584-6694 Fax: (918) 584-6229

Certification UnknownT R

Psychology Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082Excl. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021

Certification UnknownT R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 99

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Pulmonary Diseases Dennis M. Parker, M.D. 3366 NW Expressway Ste 660 pulmonary (lungs) Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Brandy all except respiratory diseasePhone: (405) 917-5439 Fax: (405) 494-0849

American Board of InternalMedicine, Am Bd - Pulmonary Disease

T R MITF

Radiology Douglas Preston Beall, M.D. 1800 Renaissance Blvd Second Floor interventional pain management of Edmondspine and all jointsEdmond, OK73013

Contact: Kim or LoriPhone: (405) 601-2325 Fax: (405) 359-2491

American Board of RadiologyT

Radiology James R. Webb, M.D. 6550 E 71 Street Ste 200 Diagnostic Radiology, pain Tulsamanagement, spine & jointsTulsa, OK74133Excl. Body Parts/Svcs:Contact: ReesanonePhone: (918) 630-0660 Fax: (918) 364-9322

American Board of RadiologyT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 100

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775

American Board of OrthopedicSurgery

T R MITF

Sports Medicine Clint Justin Basener, D.O.* 9709 E 79 Street S all within specialty TulsaTulsa, OK74133-4566

Excl. Body Parts/Svcs:Contact: Pam nonePhone: (918) 994-4068 Fax: (918) 994-4095

Certification UnknownT R

Sports Medicine Darnell E. Blackmon, M.D.* 1809 E 13 Ste 100 shoulder, knee, foot, ankle TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Rae nonePhone: (918) 925-3226 Fax: (918) 582-6060

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 101

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Bradford Boone, M.D.* 6475 S Yale Ave Ste 301 knees, shoulders, elbows TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda spine, hips, feet, ankles, hands &

rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of OrthopedicSurgery/Sports Medicine

T R

Sports Medicine James D. Cash, M.D.* 6585 S Yale Ave Ste 200 knees, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Shann nonePhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Sports Medicine T. Jeffrey Emel, M.D.* 6475 S Yale Ave Ste 301 all TulsaTulsa, OK74136-7824

Excl. Body Parts/Svcs:Contact: Linda rate only casesPhone: (918) 494-5520 Fax: (918) 494-9397

American Board of FamilyPractice/Sports Medicine

T R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 102

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Jeff A. Fox, M.D.* 6585 S Yale Ave Ste 200 knees, ankles, elbow, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: appt desk spinePhone: (918) 481-7658 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

Sports Medicine Troy A. Glaser, D.O. 6585 S Yale Ave Ste 200 spine, knees, ankles, shoulders & TulsafootTulsa, OK74136

[email protected]. Body Parts/Svcs:Contact: Appt DesknonePhone: (918) 481-7658 Fax: (918) 481-7611

American Board of Family MedicineT

Sports Medicine Bryan Hawkins, M.D.* 6585 S Yale Ave Ste 200 ankles, knees, feet, hip TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Beth neck, spine, wrists, hands, elbowsPhone: (918) 481-2767 Fax: (918) 481-7611

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 103

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Ronald S. LaButti, D.O.* 6585 S Yale Ave Ste 200 hips, knees, ankles, shoulders TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: appt desk backPhone: (918) 481-7658 Fax: (918) 481-7611

American Osteopathic Aacademy ofOrthopedics

T R MITF

Sports Medicine Gary Robert Lee, M.D.* 7125 S Braden Ave all TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Sheila NonePhone: (918) 481-8102 Fax: (918) 481-8195

American Board of Family Medicine -Sports Medicine

T R MITF

Sports Medicine Jason M. Leinen, M.D.* 3115 SW 89 Street all family & sports medicine Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Amy nonePhone: (405) 600-1411 Fax: (405) 600-1531

American Board of Family MedicineT

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 104

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Jeffrey R. Morris, D.O.* 802 S Jackson Ste 405 shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74127

[email protected]. Body Parts/Svcs:Contact: Reggieneck, spinePhone: (918) 583-4400 Fax: (918) 583-7908

American Osteopathic Board ofOrthopedfic Surgery

T R MITF

Sports Medicine Venkatesh Movva, M.D.* 6565 S Yale Ste 212 pain management TulsaTulsa, OK74136

Excl. Body Parts/Svcs:Contact: Michelle migrainesPhone: (918) 502-4008 Fax: (918) 502-4001

American Board of Internal MedicineT

Sports Medicine Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 knees, shoulders TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Rae feet, fingers, back pelvis, neckPhone: (918) 925-3226 Fax: ( ) -

American Osteopathic BoardT R

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 105

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Steve E. Randall, M.D.* 535 NW 9 Street Ste 205 pain management, family medicine, OKC, Shawneephysical medicine andOklahoma City, [email protected]

Contact: Kendra, BrittanyExcl. Body Parts/Svcs:Phone: (405) 231-2900 Fax: ( ) -facial

American Board of Family Medicine &Sports Medicin

T

Sports Medicine R. Clio Robertson, M.D.* 6585 S Yale Ave Ste 200 neck, spine, elbows, wrists, hips, Tulsaknees, anklesTulsa, OK74136

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

American Board of OrthopedicSurgery

T R MITF

Sports Medicine Derek L. West, D.O.* 8100 S Walker Ste A shoulders, knees, arms, legs, feet, Oklahoma Cityankles, hips, carpal tunnelOklahoma City, OK73139Excl. Body Parts/Svcs:Contact: Julieback, neckPhone: (405) 632-4468 Fax: (405) 632-4317

American Osteopathic Board ofOrthopedic Surgery

T R MITF

* Physician has multiple specialties.

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Date: 02/21/2014 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 14:36 (Alphabetical by Specialty) Page: 106

As of January 1, 2014

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Urology Roy Warren Bankhead, M.D. 2349 N Thompkins prostate, kidney, bladder (requests OKCrating only)Bethany, OK73008

www.urologycenters.comExcl. Body Parts/Svcs:Contact: ReneenonePhone: (405) 495-6134 Fax: (405) 787-8466

American Board of Urology R

Urology Stone M. Hallquist, M.D. 6565 South Yale Avenue Ste 912 urological surgery TulsaTulsa, OK 7413-6

Excl. Body Parts/Svcs:Contact: Carolyn all except specialty (sees

specialty only)Phone: (918) 494-9440 Fax: (918) 494-9473

American Board of UrologyT R MITF

* Physician has multiple specialties.