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Next Update: Thursday, December 19, 2024 2:50 AM CST
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ENNEN, RANDY MARK
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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: |
3312 SOUTH 70TH STREET
FORT SMITH AR 72903
Address last updated on 12/8/2011 |
| Phone #: |
(479) 452-7800 |
| Fax #: |
(479) 452-9486 |
| County: |
NOT OKLAHOMA |
| License: |
16763 |
| Dated: |
1/12/1989 |
| Expires: |
1/1/2020 |
| License Type: |
Medical Doctor |
| Specialty: |
Ophthalmology |
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| Status: |
Inactive |
| Status Class: |
Expired License |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
Washington Univ in St Louis Sch of Med, St Louis MO |
| Graduated: |
5 /
1984 |
| CME Year: |
2022 |
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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 OPHTHALMOLOGY |
| New Patients: |
Yes |
| Medicaid: |
Yes |
| Medicare: |
Yes |
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| HMO/PPO: |
Aetna HMO
Aetna PPO
BlueChoice PPO
Champ VA
CIGNA HMO
CIGNA PPO
Dept of Rehabilitation Services (DRS)
HealthChoice
Oklahoma Health Network PPO
Preferred Community Choice
Railroad Medicare
SoonerCare HMO
SoonerCare PPO
Sparks Premiercare
Tricare for Life
Tricare Standard
Tyson Preferred Network (TPN)
United Healthcare HMO
United Healthcare Options PPO |
| Hospital Privileges: |
Eastern Oklahoma Medical Center
Poteau, OK
Hospital(s) Not In Oklahoma
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