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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST
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JOHN, MICHAEL DAVID
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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.
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| Practice Address: |
620 WEST 15TH STREET
EDMOND OK 73013-3617
Address last updated on 3/3/2022 |
| Phone #: |
(405) 359-0551 |
| Fax #: |
(405) 359-3061 |
| County: |
OKLAHOMA |
| License: |
15126 |
| Dated: |
5/9/1985 |
| Expires: |
5/1/2025 |
| License Type: |
Medical Doctor |
| Specialty: |
Dermatology |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
UNIV OF LOUISVILLE SCH OF MED, LOUISVILLE KY 40202 |
| Graduated: |
5 /
1977 |
| CME Year: |
2025 |
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Pending and/or Past Disciplinary Actions:
No Disciplinary Action Taken.
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
AMERICAN BOARD OF DERMATOLOGY |
| New Patients: |
Yes |
| Medicaid: |
No |
| Medicare: |
Yes |
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| HMO/PPO: |
Aetna Elect Choice
Aetna HMO
Aetna Managed Choice
Aetna PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
BlueLincs HMO
CIGNA HMO
CIGNA PPO
CommunityCare HMO, Inc
First Health
Galaxy Health Network
Global Health HMO
Great West Healthcare
Guidestar Health Systems
HealthChoice
Humana ChoiceCare
Humana Medicare Advantage PPO
One Health Plan PPO
OSMA Health (formerly Plico PPO)
Pacificare Commercial HMO
PacifiCare of Oklahoma, Inc
PHCS (Private Healthcare Systems)
Physicians Direct Network
Preferred Community Choice
Private Healthcare Systems (PHCS)
Railroad Medicare
Secure Horizons HMO
Tricare for Life
UniCare Health Plans of Oklahoma
United Healthcare Choice
United Healthcare HMO
United Healthcare Options PPO
United Healthcare POS |
| Hospital Privileges: |
Mercy Hospital OKC
Oklahoma City, OK
OU Health - Edmond (frmrly Edmond Medical Center)
Edmond, OK
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Primary Supervisees(s):
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| Name: |
Type: |
License Number: |
Full/Part Time: |
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MARIA PRUDHOMME
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APRN |
10652 |
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