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Oklahoma Board of Medical Licensure and Supervision

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Next Update: Thursday, December 19, 2024 2:50 AM CST

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IDSTROM, MARK EDMAN       
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: EDMOND MEMORIAL HOSPITAL
1 SOUTH BRYANT
EDMOND OK 73134
Phone #:
Fax #:
County: OKLAHOMA
License: 12930
Dated: 10/3/1980
Expires: 6/30/1989
License Type: Medical Doctor
Specialty: Diagnostic Radiology
Other Specialty
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: UNIV OF MN MED SCH, MINNEAPOLIS MN 55455
Graduated: 6 / 1975
CME Year:
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF RADIOLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
EDMOND MEMORIAL HOSPITAL
1 SOUTH BRYANT
EDMOND OK 73134

Phone #:
Fax #:

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