Convicted ex-USA Gymnastics physician Larry Nassar treated athletes at the famed Karolyi Ranch near Houston without a Texas medical license, the state's medical board confirmed to The Dallas Morning News on Wednesday.

“If he had been practicing medicine in the state of Texas he should have held a license issued by the Texas Medical Board,” a board spokesman wrote in an email to The News.

The longtime USA Gymnastics doctor - who admitted to molesting USA gymnasts for years under the guise of “treatment” - appeared to have worked under the radar in Texas, operating in a sort of regulatory gray area Texas has long accepted.

Questions of Nassar’s licensing history in Texas surfaced Wednesday within hours after he was sentenced by a judge in Michigan to 40 to 175 years in prison.

“I just signed your death warrant,” Ingham County Judge Rosemarie Aquilina said.

Nassar had already been sentenced to 60 years in federal prison for child pornography crimes.

But gymnasts, U.S. senators and many others across the country continue to call for USA Gymnastics and the United States Olympics Committee to mend what's seen as a lapse in accountability that enabled Nassar's abuse.

Texas authorities confirmed Tuesday they were investigating the Karolyi Ranch, which USA Gymnastics severed ties with last week.

By law, any out-of-state physician traveling with a sports team to Texas - say during a Dallas Cowboys game - is practicing here without a license, according to the Texas Medical Board.

To do so, technically, is a third-degree felony. But Texas officials have not enforced that law.

“Traveling team doctors/athletic trainers/etc is national issue not unique to Texas as laws vary state-to-state,” said Jarrett Schneider, Texas Medical Board spokesman.

To be fair (and I'm no shill for state agencies), it was up to the #USOC to make sure physicians they employ had proper credentials. The credentialing agency can't can't visit every business. https://t.co/DgOJWRm9rD — T.L. Langford (@tlangford) January 24, 2018

State Sen. Don Huffines, R-Dallas, tried to remedy the situation in 2017 when he proposed a bill that would have exempted out-of-state doctors from licensing requirements when visiting Texas for specific sporting events. The bill did not pass.

Huffines’ bill only covered specific events like a game and did not include provisions for teams traveling with doctors to regular training facilities in Texas.

Though Nassar practiced in Texas without a license, he did apply for and was granted licenses in both Georgia and Colorado in 1996, records show. USA Gymnastics competed in the Games in Atlanta in 1996, while Colorado Springs had long been the Olympic team’s headquarters. Nassar was appointed the national medical coordinator for USA Gymnastics that year.

However, records do not show Nassar ever receiving a Texas medical license. Several former gymnasts who were molested by Nassar told the court in Michigan that Nassar abused them specifically at the USA Gymnastics National Team Training Center at Karolyi Ranch where they trained.

When unlicensed doctors in Texas come to the attention of the state’s medical board, they are issued a “cease and desist” letter from the licensing agency, Schneider said.

No such letters were ever sent to Nassar, indicating that the former Olympic team doctor never came to the board’s attention.

While complaints about doctors are secret in #Texas, cease and desist letters to unlicensed doctors are not. There were no cease and desist letters ever sent to Larry #Nassar. In other words, he flew under the radar here. For years. #txlege #gymnastics — T.L. Langford (@tlangford) January 24, 2018

Olympic gymnast McKayla Maroney, who medaled twice in the 2012 London Games, had previously stated that Nassar treated and abused girls at the ranch for more than 15 years.

Nassar received his osteopathic medical degree from Michigan State University in 1993. He served as a faculty member at MSU's College of Osteopathic Medicine until September 2016.

His Michigan license was suspended a year ago, shortly after 18 victims filed a federal lawsuit alleging sexual assault, battery, molestation and harassment between 1996 and 2016. Nassar’s license was eventually revoked by a Michigan disciplinary board.

Twitter: @JoriEpstein, @tlangford