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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, December 21, 2024 3:49 AM CST
Next Update: Saturday, December 21, 2024 12:00 PM CST

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GODDARD, MICHAEL WILLIAM       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: COMMUNITY HEALTH SHAWNEE FAMILY MEDICAL CENTER
130 N. BROADWAY
STE. # 300
SHAWNEE OK 74801

Address last updated on 6/9/2023
Phone #: (405) 395-0399
Fax #: (405) 395-0330
County: POTTAWATOMIE
License: 10925
Dated: 7/14/1976
Expires: 7/1/2025
License Type: Medical Doctor
Specialty: Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: / 1975
CME Year: 2027
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
9/23/2004 License Reinstated
1/29/2004 Suspension, License
Board Filings and/or Orders:
02/12/2004
12/11/2003
12/11/2003
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Coventry Health Care National Network
Global Health HMO
HealthChoice
Secure Horizons HMO
SoonerCare HMO
SoonerCare PPO
United Healthcare Choice
United Healthcare HMO
Hospital Privileges: None listed
Locations: Hours: Languages:
COMMUNITY HEALTH SHAWNEE FAMILY MEDICAL CENTER
130 N. BROADWAY
STE. # 300
SHAWNEE OK 74801

Phone #: (405) 395-0399
Fax #: (405) 395-0330
Mon: 8:30AM - 5:00PM
Tue: 8:30AM - 5:00PM
Wed: 8:30AM - 5:00PM
Thu: 8:30AM - 5:00PM
Fri: 8:30AM - 5:00PM
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
CYNTHIA GUERRERO APRN 90841
MARTINE NGAMELUE-KOUEMO APRN 82455

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